Report a Hazard

Hazard Report

This form should be used to record any new hazards identified onsite. The event specific hazard register is available near technical ops.
Report date and time:*

DayMonthYear
Date
24 Hour Time - HH:MM
Uno Loco Job Number (Please see Uno Loco Staff for this number)
If number is known
Event Name:*
Hazard reported by:*

First NameLast Name
Email (If we need to contact you for follow up questions)*
example@example.com
Phone Number

Country CodeArea CodePhone Number
Reporting as:*
Hazard Location (Please provide specific details):*
Describe the Hazard (Please provide as much detail as possible)*
For more information and help with scoring please click link below:

Risk Definitions Matrix
Likelihood of injury:

Rare - 1Unlikely - 2Possible - 3Likely -4Almost certain - 5
Consequence / Impact:

Insignificant- 1Minor - 2Moderate - 3Major -4Catastrophic - 5
Risk Level:
1-3 = Low / 4-9 = Medium / 10-15 = High / 16-25 = Extreme
Calculation:

Likelihood x Consequence =

Hazard Rating
Controls Required
Upload supporting photos:

Cancelof
Can this Hazard be eliminated?*

YesNo
Further Comments
By submitting this report you will let an Uno Loco team member know that a hazard report has been submitted.*

Yes
Should be Empty:

Hazard Report