Information
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Hazard reported by
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What is your contact phone number?
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Which employment type are you?
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Which project is this hazard located on
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What is your current address?
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Select date
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Provide a brief description of where the hazard is located, e.g. hydrant number, or asset such as Chambers Flat Chemical Room safety shower
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Is this a Safety or Environmental hazard?
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Please describe the hazard
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What category does this hazard fit into?
- Tools and Equipment
- Behaviour (e.g. body position)
- Body use / manual handling
- PPE
- Communication
- Housekeeping / environment
- NA
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Which sub category best describes the hazard?
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Which sub category best describes the hazard?
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Which sub category best describes the hazard?
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Which sub category best describes the hazard?
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Include a photo of the hazard. You can add multiple photos.
Include a photo of the hazard
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Add a photo of the hazard
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Please determine the Risk Rating for this hazard.
The tables contained in this hazard report allow qualitative measures of the likelihood and consequence of risk to be assessed.
During the risk assessment phase, a comprehensive list of undesired events or hazards that could pose a threat to each element of the activity should be identified.
Each threat or situation should then be analysed in order to estimate the likelihood of the occurrence of the event and the expected consequences should the event occur.
The combination of likelihood and consequence will allow a level of risk to be estimated.
To use the Risk Analysis Matrix, simply select the level of likelihood (A –E) then move across to the selected consequence column (1 – 5).
The intersecting point will give a level of risk from Extreme to Low. -
Description of the Measure of Consequence levels
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What is the Measure of Consequence for this hazard?<br>(What is the most probable consequence should the unwanted event or accident occur)<br>
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Description of the Measure of Likelihood levels
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What is the Measure of Likelihood for the consequence to occur for this hazard?<br>(What is the realistic likelihood of the unwanted event, accident or circumstance occurring)
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What is the Risk Rating for this hazard?
Take your Consequence Level and your Likelihood level, and find the intersecting point on the Risk Matrix below. -
What was the determined risk rating, before you implement any controls?
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Immediate action required, activity must not start or be stopped if started. Contact your supervisor immediately
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Immediate action required, activity must not start or be stopped if started. Contact your supervisor immediately
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Identify hazards and implement controls. Contact Supervisor to confirm suggested controls are adequate.
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Identify hazards and implement controls. Controls usually identified by routine process
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Were you able to rectify the hazard at the time of identification?
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What interim control have you put in place until the hazard can be rectified, e.g. barricading, information tag.
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Include a photo of the interim control. You may include more than one photo.
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Include a photo of the interim control
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Are further controls required to make this hazard safe?
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What action did you take to resolve the hazard?
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Please include a photo of the rectified hazard
Add a photo of the rectified hazard
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Include a photo of the rectified hazard
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Priority of Risk Treatment options.
Try to eliminate first, PPE is the last option. -
What type of risk treatment is the control that you have identified / implemented?
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Why did you select this risk treatment option?
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Determine the risk rating of the hazard, now you've put controls in place. You need to ensure your implemented controls don't introduce another hazard / risk
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What is the Measure of Consequence for this hazard?<br>(What is the most probable consequence should the unwanted event or accident occur)<br>
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What is the Measure of Likelihood for the consequence to occur for this hazard?<br>(What is the realistic likelihood of the unwanted event, accident or circumstance occurring)
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What is the Risk Rating for this hazard?
Take your Consequence Level and your Likelihood level, and find the intersecting point on the Risk Matrix below. -
What was the determined risk rating?
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Immediate action required, activity must not start or be stopped if started. Contact your supervisor immediately
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Immediate action required, activity must not start or be stopped if started. Contact your supervisor immediately
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Identify hazards and implement controls. Contact Supervisor to confirm suggested controls are adequate.
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Identify hazards and implement controls. Controls usually identified by routine process
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Who is your supervisor / contract manager?
- Troy Dawson
- Jim Rishworth
- Malcolm Potts
- Gary Sinnott
- Greg Kemp
- Phil Grounds
- Gareth Rees
- Julie Cuthbert
- Conor Hurley
- Marcia Harvey
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Please sign that report is complete and accurate
