Information

  • Document No.

  • Brief description of the hazard

  • Prepared by

  • Location

Details of the Report

  • ALL HAZARDS MUST BE IMMEDIATELY REPORTED TO YOUR SUPERVISOR OR CONTRACTOR IN ADDITION TO SUBMITTING THIS FORM

  • Type of Report

  • When was the observation made?

  • Name of Supervisor

  • Provide a detailed description of the report.

  • Add photos?

  • Has this been reported to the person who can action this report?

  • Name of person reported to?

  • Has the hazard been fixed?

  • If yes please provide details of actions taken. Including photos if possible.

  • When must this be fixed?

  • ALL HAZARDS THAT REQUIRE ATTENTION IN LESS THAN 1 DAY MUST BE FIXED IMMEDIATELY OR YOUR SUPERVISOR OR CONTRACTOR NOTIFIED IMMEDIATELY.

  • Provide any additional information or comment. Draw a sketch here if appropriate.

  • Signature of Person Reporting Hazard

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.