Report type

Report Type

Description of Hazard

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

Photos of Hazard / Observation
Assessment of Risk

Reasonable forseeable outcome if an incident occurred

Risk Rating is the product of Consequence and Likelihood as per below image

Add media
Control the hazard
Corrective Action

Describe actions ( If applicable)

Photos of corrective action
Name and signature of issuer

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.