Report of Hazard

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of hazard

• What is the hazard ?

• Take a photo showing what the hazard is

  Media

• Where is the hazard ?

• Take a photo showing here the hazard is

  Media

• Type of hazard

  Select Manual Tasks Gravity Electricity Machinery & Equipment Hazardous Chemicals Extreme Temperature Noise Radiation Biological Pshycosocial

  • Manual Tasks
  • Gravity
  • Electricity
  • Machinery & Equipment
  • Hazardous Chemicals
  • Extreme Temperature
  • Noise
  • Radiation
  • Biological
  • Pshycosocial

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

• Add photo of hazard

  Media

• What could happen as a result of the hazard?

• What have you or others done now to reduce the risk ?

• Take a picture of your completed actions

  Media

• Is the risk from the hazard now acceptable ?

  Yes

  No

  N/A

• Your ideas on how to permanently fix the hazard:

• Please give this report to the Account Manager and or the Manager or Supervisor where the hazard is located. You will be notified within 2 working days of either the action taken or to be taken

Manager or Supervisor to complete this section

• Corrective Action Taken:

• Is the risk from the hazard now acceptable ?

  Yes

  No

  N/A

• Situation Corrected:

  Yes

  No

  N/A

• Employee Notified ?

  Yes

  No

  N/A

• Date Employee Notified

  Date

• Signed:

  Sign