Electrical Hazard Report - Rowland & Briggs

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of Hazard

• Explain the type of hazard and possible cause

• Type of hazard present

  water damage

  smoke damage

  trip hazards

  falling objects

  exposed conductors

• Photo of Hazard if possible

  Media

Assess the Risk

• What would be a reasonably foreseeable outcome if an accident occurred.

• Consequence of Hazard

  Select Low Medium High Extreme

  • Low
  • Medium
  • High
  • Extreme

• Likelihood

  Almost Certainly

  Likely

  Possible

  Unlikely

  Rare

• Risk Rating

  Low

  Medium

  High

  Extreme

Control the Hazard

• Describe what actions have been undertaken to make the hazard safe

• If possible take a photo of the completed actions eg; Installed Hazard Tag

  Media

Long term recommendations

• Do you have any further recommendations or suggestions including further comments.

Person raising the Hazard Inspection sign off.

• Rowland & Briggs representative sign off.

  Sign

Site supervisor, Safety Advisor or Manager comments

• What follow up action is required in your opinion?

• Do you recommend that a formal risk assessment be conducted following this report?

  Yes

  No

• Signature of Supervisor, Safety Advisor or Manager.

  Sign