Audit

Hazard / Near Miss Repot

Reported By:

Description of Hazard / Near Miss:

Add media

IF HAZARD IS IMMEDIATE RISK
REPORT TO YOUR SUPERVISOR IMMEDIATELY

Supervisors Corrective Actions:

Date:
Supervisor's Signature:
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.