Information

Title

  • Location

  • Conducted on

  • Prepared by

Description of hazard

  • Report Type

  • Type of observation

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

  • Photos of Hazard / Observation

Assessment of risk (Not applicable for positive observation)

  • Reasonable foreseeable outcome if incident occurred

  • Consequence

  • Likelihood

  • Risk Rating

Control of hazard ( Not applicable for positive report)

  • Corrective actions

  • Describe actions (if applicable)

  • Photos of corrective actions

Long term recommendations (if applicable)

  • Describe recommendations

  • Drawing of recommendations (if applicable

Name and signature of issuer

  • Add signature

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.