Information
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Site conducted
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Prepared by
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Date and Time
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Is this a Hazard or a Near-miss
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Is this Hazard on the site you are at now?
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Click the location tab
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Click to enter more information and location of the hazard or near-miss
Description
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Existing Hazard Controls
https://drive.google.com/drive/u/2/folders/1L-KS219ser4XHP7HHwoYd7iLvF7XzjrV?ogsrc=32 -
Add a Hazard
Hazard
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What type of hazard is it
- Potential Fall from Heights
- Electrical Hazard
- Unsafe Equipment / Tools
- Unsafe Practice / Actions
- Expired Permits
- Confined Spaces
- Slip, trip, same level fall
- Exposed Earthworks
- Vehicle Traffic
- Pedestrian Traffic
- Other
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Give a short description of the hazard or near-miss or call your site supervisor.
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Take a photo if possible
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Please rate the hazard using this matrix
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Please eliminate the hazard or minimize it, continue if it safe to do so
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Give a short description of what actions were taken to eliminate or minimise the hazard
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Take a photo if possible
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Immediately notify your site manager. Please eliminate the hazard or minimise it if possible , Do not continue work in the area of the hazard until the site manager has authorised work to continue.
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Give a short description of actions taken.
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Take a photo if possible
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Activity should be stopped immediately. The site supervisor must authorise in writing that he/she is satisfied with the control measures before activity may be resumed.
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Take a photo if possible
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Site supervisor / duly authorised person's comments or authorisation to continue activity.
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Site manager: Hazard has been acknowledged and work / activity is authorised to continue.
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Describe what controls have been applied and also the relevant control document's, procedure's or policy's reference nr.
Submit Form
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Person reporting hazard - sign and submit
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Enter contact nr:
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Additional comments if relevant.
