Title Page
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Conducted on
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Prepared by
General Details
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WHS Ticket Number
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Date of Ticket
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Person Reporting the Hazard
Assessment Details
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Delivery Address of Hazard
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Specific concerns to be assessed
Hazard Items for Carriers
Parking at or outside of delivery location
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Images Relevant to this Hazard
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Assessment Findings
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Assessed Risk
Forward entry into delivery location
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Images Relevant to this Hazard
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Assessment Findings
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Assessed Risk
Reverse entry into delivery location
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Images Relevant to this Hazard
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Assessment Findings
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Assessed Risk
Ability to unload stock at delivery location
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Images Relevant to this Hazard
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Assessment Findings
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Assessed Risk
Ability to exit delivery location
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Images Relevant to this Hazard
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Assessment Findings
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Assessed Risk
Overall Assessment and Recommendations
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Overall Risk Rating
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Recommendations
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Date completed
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Signature of Assessor