Hazard Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of Hazard

• Type of Hazard

  Manual Task

  Slip/Trip/Fall

  Electricity

  Machinery & Equipment

  Guards

• Explain the hazard and the context in how the hazard poses a risk

• Add media

  Media

Assess the risk

• What would a reasonable foreseeable outcome be if an incident occurred?

• Consequence

  Low

  Minor

  Moderate

  Major

  Catastrophic

• Likelihood

  Almost certain

  Likely

  Possible

  Unlikely

  Rare

• Risk Rating

  Low

  Medium

  High

  Extreme

Control the hazard

• Describe what you have done to make the hazard safe!

• Add media

  Media

Recommendations

• What are your recommendation to correct the hazard.

Send report to HSSE Manager,Department Manager, and Supervisor. If it requires a facility maintenance copy to the Facilty Manager.

• Select date

  Date

• Person completing the report

  Sign