SMYL HAZARD IDENTIFICATION REPORT

ASSESSMENT INFORMATION

• By competing this activity, you will be assessed towards the units of
  
  PSPOHS201B Follow workplace safety procedures
  BSBITU101A Operate a personal computer
  BSBCMM101A Apply basic communication skills
  GENENP101C Apply an enterprising approach in a team project
  LDWA103C. Participate effectively in a team
  LDWA105C. Develop problem solving skills
  
  
  
  
  

HAZARD FORM COMPLETED BY: NAMES:

• Location / Site Description

• Add signature

  Sign

• Add signature

  Sign

• Add signature

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• Select date

  Date

HAZARD IDENTIFICATION

• Brief details of the hazard, remember What Where Why

• Perceived risk of risk 1 low risk 5 high risk

• Take a photo of the hazard to attach to this report

  Media

WHAT CONTROLS HAVE OR NEED TO BE APPLIED FOR THE CONTROL OF THIS HAZARD

• Elimination - can this hazard be removed from the worksite

• Substitution - can this hazard be replaced with something safer

• Engineering - can this hazard be fixed

• Administrative - if hazard can not be removed is there instructions that can be produced so you can work around hazard safely

• Personal Protective Equipment - if the hazard can not be removed, is there special clothes or equipment that must be worn while working around this hazard

IMMEDIATE ACTION TAKEN

• Did you do anything when you saw the hazard to prevent any incidences happening?

  Yes

  No

  N/A

• What did you do? explain

FURTHER ACTION REQUIRED

• Is any further action required in relation to this hazard

  Yes

  No

  N/A

• Explain: What is the action? Who needs to do it? When do they need to do it by ie date?

HAZARD CONTROLLED

• Has the hazard been controlled?

  Yes

  No

  N/A

• If no, has the hazard been recorded by someone on the hazard register and action plan

  Yes

  No

  N/A

Occupational Health & Safety Officer

• Name of OHS Officer

• Signature of OHS Officer once sighted form

  Sign

• Select date

  Date