Hazard Observation.

• Name:

• Company:

• Location:
  Address

• Enablon No:

• Package No:

  Select AA030 - Redpath AA037 - ASD CC001 - BGC CC006 - Hutchinsons CX001 - McNab CX002 - Mainteck CE012 - Lend Lease

  • AA030 - Redpath
  • AA037 - ASD
  • CC001 - BGC
  • CC006 - Hutchinsons
  • CX001 - McNab
  • CX002 - Mainteck
  • CE012 - Lend Lease

• Hazard:

  Select YES NO

  • YES
  • NO

• Near Miss:

  Select YES NO

  • YES
  • NO

• Date and Time:

  Date

• Person Involved (if any):

• Equipment Involved (if any):

• Impact Type:

  Select Safety Environment Equipment Damage Reputation Health Legal/Regulatory Social Material Losses/Business Interruption

  • Safety
  • Environment
  • Equipment Damage
  • Reputation
  • Health
  • Legal/Regulatory
  • Social
  • Material Losses/Business Interruption

Description of Hazard or Near Miss

• Details:

• Add Photos:

  Media

Severity Ranking?

• Low = (1-5), Medium = (6-12), Significant = (13-17), Significant = (18-20), High = (21-25)

  1-5

  6-11

  13 - 17

  18 - 20

  21 - 25

• HPH is required where the Potential Severity is a 4 or 5.

Immediate action taken:

• Detail:

• Add Photos:

  Media

Further Actions Required:

• Further action required?

  YES

  NO

• Add comment where required.

Supervisors Name - Signature - Time - Date:

• Supervisors Name:

• Date and Time:

  Date

• Signature:

  Sign