Hazard Report fForm MARSH 290511 Issue 5

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• MARSH DOCUMENT 29/04/2011 ISSUE 5

• Hazard Report Form

Hazard Identification

• Part A (To be completed by Property Manager)

• Description of hazard:

  Safe

  At Risk

  N/A

• Location:

• Drawing of issue/location:

  Drawing

• Date identified:

  Date

• Hazard identified by (name):

• Person notified (name):

Risk Assessment and Control

• Part B (To be completed by Property Manager)

• Refer Risk Management for details in Likelihood, Consequence and Risk Level.

• Likelihood:

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Consequence:

  Extreme

  High

  Medium

  Low

  Insignificant

• Risk Level:

  Very High

  High

  Medium

  Low

  Insignificant

• Recommended Hazard Control (consider short, mid and long term options):

• Date of recommendation:

  Date

• Recommendation Approved:

  Yes

  No

• Approved By (name):

• Person/s responsible for implementation:

• Implementation Date:

  Date

• Authorised By:

Hazard Control Review

• Part C (To be completed by Centre Manager)

• Hazard control reviewed by:

• Date controls implemented:

  Date

• Control satisfactory:

  Yes

  No

• If no, what course of action should be taken:

  Yes

  No

  N/A

• Signature:

  Sign

• Date:

  Date