• Document No.

  • Client/Witness

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Description of hazard

  • Nature of hazard/dumped materials located

  • Contact details of person reporting hazard

  • Type of hazard/dumped materials

  • Details of the identified Hazard/dumped materials including any identifiable materials located.

  • Add photo of hazard

  • Location of the hazard/materials located

Assess the risk

  • What would be a reasonably foreseeable outcome if the materials were left insitu?

  • Consequence

  • Likelihood

  • Risk Rating

Risk Management officer to complete (this point onwards)

  • Name of Investigating Officer

Control the hazard/materials

  • Type of control

  • Other type of control

  • Describe actions undertaken to clean up the site and to locate possible offender.

  • Take a picture

  • Select date

Follow up actions

  • What follow up action is required

Person responsible for follow up

  • Who is responsible for follow up action?

  • Corrective action complete?

  • Take a picture of completed action

  • If incomplete when will corrective action be completed?

  • Date of review

  • Responsible person sign off

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.