Hazard Report Form
Use this form if you identify a hazard. A hazard is a situation which presents the potential for an incident, accident or near miss. Do not use this form to report a near miss, incident or injury. Instead fill in the Incident Report Form.
Full Name
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First Name
Last Name
Hazard Details:
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Please details the date (and time if relevant) and location that the hazard occurred/was identified, and then describe the hazard (and potential risk/s associated)
Any witnesses to the Hazard?
What do you think can be done to resolve the problem?
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Was there any immediate action taken when the hazard was identified?
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Yes
No
If yes, please provide details?
Submit
Should be Empty: