MD Korea Site Hazard Report

Title

• Location

• Conducted on

  Date

• Prepared by

Description of hazard

• Report Type

  Hazard Report

  Positive Report

• Type of observation

  Select 1 Housekeeping 2 PPE 3 Barriers & Signs 4 Scaffold and Access 5 Permit to work 6 Traffic and safe walkways 7 Machinery & Equipment 8 Lifting Operations 9 Working at Height 10 Confined space entry 11 Fire & Fire fighting 12 Ventilation 13 Noise 14 Vibration 15 Slips, Trips & Falls 16 Dropped objects 17 Electrical 18 Positive report 19 Pressure testing & flushing

  • 1 Housekeeping
  • 2 PPE
  • 3 Barriers & Signs
  • 4 Scaffold and Access
  • 5 Permit to work
  • 6 Traffic and safe walkways
  • 7 Machinery & Equipment
  • 8 Lifting Operations
  • 9 Working at Height
  • 10 Confined space entry
  • 11 Fire & Fire fighting
  • 12 Ventilation
  • 13 Noise
  • 14 Vibration
  • 15 Slips, Trips & Falls
  • 16 Dropped objects
  • 17 Electrical
  • 18 Positive report
  • 19 Pressure testing & flushing

• Description of Hazard and how it poses a risk ( or positive observation)

• Photos of Hazard / Observation

  Media

Assessment of risk (Not applicable for positive observation)

• Reasonable foreseeable outcome if incident occurred

• Consequence

  1 Insignificant

  2 Minor

  3 Moderate

  4 Major

  5 Catastrophic

• Likelihood

  1 Rare

  2 Unlikely

  3 Possible

  4 Likely

  5 Almost Certain

• Risk Rating

  1 Low

  2 Moderate

  3 Significant

  4 High

Control of hazard ( Not applicable for positive report)

• Corrective actions

  1 Reported to SHI

  2 Supervisor / Worker informed

  3 Corrected immediately

  3 As described below

• Describe actions (if applicable)

• Photos of corrective actions

  Media

Long term recommendations (if applicable)

• Describe recommendations

• Drawing of recommendations (if applicable

  Drawing

Name and signature of issuer

• Add signature

  Sign