Hazard Report

• Hazard number

• Site

• Conducted on

  Date

• Prepared by

• Location/ work area
  Address

Hazard identification

• Description of Hazard

• Image of Hazard

  Media

• Can work in this area continue?

  Yes

  No

• Has personnel in the area been informed?

  Yes

  No

• What measures have been taken to reduce the risk from this hazard when identified?'

• Hazard corrective action owner:

• Hazard corrective action completion target date:

  Date

• Hazard reported by:

  Sign