Information
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Hazard No.
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Location
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Conducted on
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Hazard Identified By
Hazard Identified
- Hazard
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What is the category of the hazard?
- Vehicles and Driving
- Electrical
- Asbestos
- Asset Condition
- Confined Space
- Environmental Risk
- Fixed Plant or equipment
- Hot works
- Livestock
- Mobile Plant (tractors, side-by-sides)
- Working at Heights
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Has a critical control failed?
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What Critical Control Failed?
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What failed resulting in exposure to the risk?
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Describe the risk to workers, the environment or assets?
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Add a photo of the Hazard where possible?
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What is the most likely consequence if the hazard is not controlled?
- Class 1 - Fatality / > 50k Damage / > 1 month enviro impact
- Class 2 - RWI / >$15k damage / < 1 month enviro impact
- Class 3 - FAI / >$15k damage / > 1week enviro impact
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What action was taken to immediately control the risk to workers, the environment or assets?
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Is the action now controlled to an tolerable (acceptable) limit?
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Notify your relevant line manager of the situation immediately
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Assign further actions to be taken to adequately control the hazard and risk.
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Are there any further actions required to prevent the hazard or risk reoccurring?
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Assign actions to the relevant person
