Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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This form is to be used to list details of a hazard that has been identified onsite, or offsite, involving installers working on Clayton's kitchens installations .
HAZARD DESCRIPTION
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Please give a detailed description on what hazard has been identified, person or people involved, and any other information relevant to this incident
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Was this hazard identified by Clayton's site coordinator or staff?, if no, please give details of who identified the hazard
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How would you currently class the hazard. For example, is it causing immediate danger to anybody, or is it a potential hazard only affecting those identified on this form. Please give details below
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If any immediate danger has been identified, it must be rectified, or removed immediately
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Please attach as many relevant photos as practical of the hazard.
CAUSE AND SOLUTION
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Please give a description of why or what has caused this hazard
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Can something be done immediately to remove the hazard? Give details.
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What action will be taken to remove the hazard, or reduce the risk?
RECORDING AND NOTIFICATION OF INCIDENT
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It is the responsibility of the person completing this form, to forward a complete copy of the audit to Clayton's ohs department to be reviewed and added to file.
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Has the installer been given a deadline for rectifying the hazard. Please list all details
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Has the installer been removed from the worksite for any reason relating to the installers safety or non-compliance ? Please give all details
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Please give any other information that may be relevant
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Please add any other relevant pictures etc
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I agree that all information detailed on this form is correct, and at the completion of this form, am satisfied that there is no immediate danger to anybody. I agree that I will act on all requirements and recommendations listed within this form.
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Auditors signature
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Installer signature
