Site Hazard report (MD)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of Hazard

• Select date

  Date

• Report Type

  Hazard Observation

  Positive Observation

• Type of Observation

  Select 1 Housekeeping 2 PPE 3 Barriers and signs 4 Scaffold and access 5 Permit to work 6 Traffic & safe walkways 7 Machinery & Equipment 8 Lifting ops. 9 Working at height 10 Confined space entry 11 Fire & fire fighting 12 Ventilation 13 Noise 14 Vibration 15 Slips &Trips 16 Dropped objects 17 Electrical

  • 1 Housekeeping
  • 2 PPE
  • 3 Barriers and signs
  • 4 Scaffold and access
  • 5 Permit to work
  • 6 Traffic & safe walkways
  • 7 Machinery & Equipment
  • 8 Lifting ops.
  • 9 Working at height
  • 10 Confined space entry
  • 11 Fire & fire fighting
  • 12 Ventilation
  • 13 Noise
  • 14 Vibration
  • 15 Slips &Trips
  • 16 Dropped objects
  • 17 Electrical

• Description of Hazard and how it poses a risk (or positive observation)

• photos of hazard / Observation

  Media

Assessment of risk (Not applicable for positive observation )

• reasonable foreseeable outcome if incident occurred

• Consequence

  1 insignificant

  2 Minor

  3 Moderate

  4 Major

  5 Catastrophic

• Likelihood

  1Rare

  2 Unlikely

  3 Possible

  4 Likely

  5 Almost Certain

• Risk Rating

  1 Low

  2 Moderate

  3 Significant

  4 High

Control of hazard ( Not applicable for positive observation)

• Corrective actions

  1 Reported to SHI

  2 Supervisor / worker Informed

  3 Corrected immediately

  4 As described below

• Describe actions (if applicable)

• Photos of corrective actions

  Media

Long term recommendations (If any)

• Describe recommendations

• Drawing of recommendation (If applicable )

  Drawing

Name and Signature of issuer

• Add signature

  Sign