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
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SECTION 1 COMPLETE BY PERSON MAKING REPORT AND HAND TO DIRECT SUPERVISOR/MANAGER
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Hazard Reported By
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Date and Time when Hazard was first identified
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Brief Description of Hazard
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Where is the Hazard Located?
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Potential Risk/s
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Potential Control Measures
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SECTION 2 COMPLETED BY DIRECT SUPERVISOR/MANAGER
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Calculate the risk
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Likelihood
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Consequence
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Rating
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Risk Rating
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Detail the actions needed to prevent hazard
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Signature - person making report
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Signature - direct supervisor/manager
