Information

  • Project Name

  • Site address

  • Conducted on

  • Prepared by

  • Personnel reporting the hazard, if not the person filling out this form.

  • Document No.

Description of hazard

  • Type of hazard

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

  • Add photo of hazard

Assess the risk

  • What would a reasonably foreseeable outcome be if an incident occurred

  • Consequence

  • Likelihood

  • Risk Rating

Control the hazard

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

  • Take a picture of your completed actions

Long term recommendations

  • Do you recommend any long term solutions or do you have any additional comments

Person raising hazard sign off

  • Please sign and send to your HSR, Supervisor, Safety Advisor or Manager

HSR, Supervisor, Safety Advisor or Manager comments - if present at time of report.

  • What follow up action is required in your opinion

  • Do you recommend that a formal risk assessment be conducted

  • 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.