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

Controls Applied

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

IMMEDIATE ACTION TAKEN

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

  • What did you do? explain

Further action required

FURTHER ACTION REQUIRED

  • Is any further action required in relation to this hazard

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

Hazard controlled

HAZARD CONTROLLED

  • Has the hazard been controlled?

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

Occupational Health & Safety Plan

Occupational Health & Safety Officer

  • Name of OHS Officer

  • Signature of OHS Officer once sighted form

  • Select date

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