26 / 33
Page 26 of 33
HAZARD REPORT FORM
– for any hazard incl udi ng repair or maintenance. Copy to
Supervisor when a hazard is i denti fied. If a risk to yourself or other persons such as
company empl oyees,
IMMEDIATELY INFORM THE COMPANY REPRESENTATIVE OR SUPERVISOR.
DATE:
REPORTED BY:
LOCATION:
SUPERVISOR:
HAZARD
IMMEDIATE ACTIONS TAKEN
SUGGESTED FIX / CONTROLS / SOLUTIONS
FOLLOW UP ACTIONS TAKEN
UNDERTAKEN BY:
DATE:
SIGNATURE
FURTHER FOLLOW UP / MONITORING REQUIRED YES /
NO
FOLLOW UP SUGGESTED DATE:
FEEDBACK TO PERSON REPORTING HAZARD
HAZARD REPORT COMPLETED: YES / NO
MANAGER OR DELEGATE (SIGN):
DATE:
Report to be filed in site file and reviewed at time of internal audit
TO BE COMPLETED BY REPORTI NG PERSON / SUPERV I SOR