Once per job / new process / equipment:

Ongoing:

Per Incident:

Name of person completing this form:

Name if listed as other above:

Date completing this form:

YYYY

Hazard Report number this form relates to:

Date the hazard was identified:

YYYY

Time the hazard was identified:

Hour

Minute

Second

Description of the hazard:

Was the Hazard located as the result of an incident or injury?

If yes, complete injury report also.

yes

Hazard Rating

Has action been taken to reduce or remove the Hazard?

yes

If yes, describe what action was taken. If no, describe why no action taken.

Has the hazard been permanently controlled?

yes

If ‘YES’ What action was taken to control the hazard? If ‘NO’ What additional action is required to prevent injury or damage to property?

Initiator of Report to be advised on actions taken and/or progress

P6 PROJECTS

From Foundations to Finishing Touches

ABN 34612640114
BLD 307247