Title Page

  • Document No.


  • Project Number & Project Name:

  • Hazard report number: (project number - hazard report number. E.g.4665-001)

  • Hazard report date

  • Hazard reported to (name and position):

  • Responsible company:

  • Contractor name:

Hazard details:

  • Hazard location:

  • Add location
  • Work activity:

  • Hazard identified in relation to the work activity:

  • Hazard evidence (take or upload photo here):

  • Hazard risk rating:

  • An Non-Conformance report (NCR) must be issued for all high risk hazards, where the corrective action cannot be undertaken immediately.

  • NCR Number

  • NCR issue date:

  • NCR issued by (name and title):

Corrective actions details:

  • Corrective action required:

  • Corrective action to be undertaken by (company and responsible person name):

  • Within how many days should the hazard be attended to?

  • Please choose how many days:

  • Corrective Action Evidence ( take or upload photo here):


  • Signature of person reporting hazard

  • Signature of person completing the corrective action:

  • Completion of corrective action confirmed by

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.