Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Identified Hazard
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Identify hazard
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Add media
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Why is this a hazard?
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What is the risk rating?
- Extreme - Death or permanent disablement
- Major - Serious bodily injury or illness
- Moderate - Injury or illness
- Mild - Requiring first aid treatment only
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Can this hazard be reduced in the short term?
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What short term action is required to remove or reduce the risk?
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Can this hazard be reduced in the long term?
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What long term action is required to remove or reduce the risk?
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Has this hazard been reported to property management?
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Who was this hazard reported to?
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What was their response to the hazard and suggested short and or long term action required to reduce or remove the risk?
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When will this hazard be reviewed?
Signatory
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I hereby acknowledge this report to be a fair and accurate reflection of the inspected site and that the customer has been contacted to discuss the above listed items.
Review
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Review hazard frequently to determine if the hazard is still present or if any measures have been taken to reduce or remove the hazard
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Date reviewed
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Has any action been taken to remove or reduce the hazard?
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Date reviewed
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Has any action been taken to remove or reduce the hazard?
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Date reviewed
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Has any action been taken to remove or reduce the hazard?
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Date reviewed
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Has any action been taken to remove or reduce the hazard?
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Date reviewed
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Has any action been taken to remove or reduce the hazard?
