UGL Hazob

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Tick appropriate box

• Improvement suggestion

• Hazard observation

• Design sleeper

• Location of: Hazard/sleeper/improvements

Hazard type

• Workplace layout/housekeeping

• Plant and equipment

• Fall protection

• Unsecured objects

• Work practices

• Fire

• Enviroment

• Health and hygiene

• Traffic

• Chemical

• Other

• Description of Hazard/sleeper/improvements

• Additional information

Agreed actions

• Action items

• By Who

• By When

• Has Hazob been closed out

  Yes

  No

  N/A

• Date closed out

  Date

• Name and signature of who closed out

  Sign

• Photo1

  Media

• Photo 2

  Media

• Photo 3

  Media

• Photo 4

  Media