OHS Hazard Report Form

Date:

10/2/2016

Reported By:
Name:

Logan Thomson

Position:

Student

Principal and OHS Rep

Position:

Principal and OHS Rep

Reported To:
Name:
Site location:
Subject:
Incident

Near Miss

X Workplace Hazard

Description of Hazard:
The rubbish around the school could cause a slip, trip or fall

Risk Assessment Levels

-How likely is the hazard to hurt me or someone else?

Not likely
x Some likelihood
Quite likely
Extremely likely
-How badly could people be hurt?
Not badly
Somewhat badly
x Quite badly
Extremely badly
Explain your answer here.
Its dirty and people can trip

Hazardous Work Practice

What needs to be done?

x Elimination
Substitution
Isolation
Safeguards
x Instructing workers in the safest way to do something
Using personal protective equipment and clothing (PPE)
Other
Provide details below.
Elimination will get rid of the tripping hazzerds and make the school look more clean

Signature:

Date:

Copy given to:

Manager:

(Signature)

Communication Meeting:

(Signature)