NOTIFICATION OF A HAZARD (WCS)

Notification of Hazard (WCS)
In accordance with standards outlined in the Work Health and Safety Act (2011), Wonderland Community Services (WCS) is committed to maintaining a safe work environment for all staff, participants and visitors. As such, all hazards identified within the workplace environment need to be reported on the form below and submitted to the Retreat Coordinator (or line manager) as soon as possible.
Site*
Services*
STA/Day program (Short Term Accommodation/Respite or Day Program), MTA/SIL (Medium Term Accommodation and Supported Independent Living) IHC (In home care) CA (Community Access)/CHILD SAFETY
Level of Alert*
Incident Type
Report Date*

DayMonthYear
Date
Report In
Staff Reporting*

First NameLast Name
Phone*
Email*
example@example.com
Address of Hazard

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Hazard
Inside or Outside - whereabouts precisely
Photo of hazard

Cancelof
Description of Hazard/summary*
Describe any measures you or others took to reduce this risk
What else can be done in your opinion to fix this hazard/reduce this risk?
Your Signature
Name of Supervisor (who are you sending the report to)

First NameLast Name
Supervisor's Email
example@example.com
Supervisors comments
Version date 16.09.2021
Should be Empty:

Notification of Hazard (WCS)