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Hazard Report Form

Form · FORM-30056

  • Version 4
  • Miscellaneous
  • Reads on any phone

The Hazard Report Form lets workers report a hazard they have found before it leads to an incident, so the risk is recorded, addressed and controlled.

It records who is reporting and when, a description of the hazard and exactly where it is, when it was identified, and the action the worker recommends. An office use section records the date the report was received, who completed the recommended action, their signature and any comments.

It suits any business that manages risk proactively, and is especially useful where work changes often, such as construction, manufacturing and logistics. It is part of the Health and Safety Manual, whose documents refer to each other.

Preview of the Hazard Report Form

Hazard Report Form

FormVersion 4

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What it covers

14 fields

  1. Name
  2. Date reported
  3. Phone
  4. Worker or contractor
  5. Organisation
  6. Description of the hazard
  7. Exact location of the hazard
  8. Date identified
  9. Time identified
  10. Recommended action to ensure safety
  11. Date received
  12. Recommended action completed by

and 2 more

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