Information
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Document No.
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Client / Site
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Location
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Conducted on
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Entered by:
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Area:
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HAZOB Observer: (Optional)
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When was the HAZOB issue observed?
HAZOB Type
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HAZOB TYPE
EXACT LOCATION OF HAZARD / SLEEPER / IMPROVEMENTS
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Hazard Type:
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Hazard Type (multiple selections enabled)
- Workplace Layout / Housekeeping
- Fire
- Plant & Equipment
- Environment
- Fall Protection
- Health & Hygiene
- Unsecured Objects
- Traffic
- Work Practices
- Chemical
- Other (Describe)
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Hazard Details - List details or take a picture(s) of the hazards you identified - Description of Hazard / Sleeper / Improvements:
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Agreed Actions (Supervisor to complete)
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Hazard Control Details - List Action Items or take a picture of how the hazard(s) will be controlled
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By Who:
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By When:
