Caravan Industry Association of Australia - Hazard Reporting Form Template

• Park Name

• Conducted on

  Date

• Prepared by

Reported By:

• Name

• Position

Reported To:

• Name

• Position

What type of hazard is being reported?

• Incident

  Yes

  No

  N/A

• Near Miss

  Yes

  No

  N/A

• Workplace Hazard

  Yes

  No

  N/A

• Hazardous Work Practice

  Select Yes No N/A

  • Yes
  • No
  • N/A

Description of Hazard

• undefined

What needs to be done to remove hazard?

• undefined

Personnel to be notified

• Name

• Name

• Name

• Name