Title Page
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CAR Register #:
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Conducted on:
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Site Location
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Prepared by:
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Position:
Report
Details:
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Person &/or Company responsible for action:
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How was the hazard identified or reported?
- General Observation
- Accident/Incident Report
- Phone
- Complaint
- Internal Audit
- External Audit
- Other
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Reported by:
- Site Staff
- Worker
- Client
- Contractor
- Public
- Other
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Name of person who reported the issue:
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Description of the issue:
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Photo evidence of issue:
Risk Rating:
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Bay State Construction Risk Matrix:
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Risk Rating based on the Bay State Construction Risk Matrix:
- 1. High
- 2. Medium
- 3. Medium
- 4. Medium
- 5. Low
- 6. Low
Risk Management:
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Bay State Construction Risk Control:
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What controls are to be implemented to rectify the issue &/or prevent a repeat of the issue in future?
- 1. Eliminate the risk (most effective control)
- 2. Substitute with a safer alternative
- 3. Use engineering controls
- 4. Redesign to reduce risk
- 5. Isolate people from risk
- 6. Use administrative procedures
- 7. Use (PPE) personal protective equipment (least effective control)
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Describe in detail what rectification action is to be taken by the person &/or company:
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Action is to be completed by this date: