Hazard Report

Hazard Category:
1) Safety hazards2) Biological hazards3) Physical hazards4) Ergonomic hazards5) Chemical hazards6) Workload hazards7) Other

Hazard Impact, who or what is this hazard most likely to impact:
Injury to peopleDamage to EquipmentDamage to buildingsDamage to EnvironmentOther

Hazards that are likely to cause an injury to a person are highest priority and you should take immediate and reasonable action to avoid someone becoming injured.

Immediate Action

Immediate Action taken by you
Isolate with witches Hats, tape, etcIsolate with Suitable signage and Warned PeopleIsolated by Removal from UseDisposed ofReported to Supervisor / ManagerAdvised those likely to be impactedOther

You must take reasonable action to prevent injury. Please immediately re-assess what you can do to make the equipment/site safe.

The following are examples of actions you could take:

Place witches hats or safety tape around the equipment or area to form an exclusion zone
Turn power off at switch boards and place a Do Not Use sign on the equipment
Place a suitable sign in the area or on the equipment / item (i.e. out of use or wet floor sign) warning of the hazard
Inform people of the hazard
Place the item in a locked area

Your Details

Witness / Other Persons

The Hazard

Immediate Action