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  • Hazard Report Form: Completed by Staff Member

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    Chai Suwandi
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    This hazard report form documents a reported problem by having the staff member fill out their name, time, date, description of the problem, any short-term measures taken, and further action required. The manager then records the action taken to rectify the problem, who completed the action and when, signs and dates the form, and notes whether the form was returned to the person raising the issue and if the control measure was monitored and found effective.

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    This hazard report form documents a reported problem by having the staff member fill out their name, time, date, description of the problem, any short-term measures taken, and further action required. The manager then records the action taken to rectify the problem, who completed the action and when, signs and dates the form, and notes whether the form was returned to the person raising the issue and if the control measure was monitored and found effective.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views2 pages

    Hazard Report Form: Completed by Staff Member

    Uploaded by

    Chai Suwandi
    This hazard report form documents a reported problem by having the staff member fill out their name, time, date, description of the problem, any short-term measures taken, and further action required. The manager then records the action taken to rectify the problem, who completed the action and when, signs and dates the form, and notes whether the form was returned to the person raising the issue and if the control measure was monitored and found effective.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    HAZARD REPORT FORM

    Completed by staff member

    Name of person reporting problem: _____________________________

    Time: ____________ Date: __/__/__

    What is the problem? ________________________________________

    ______________________________________________________________

    ______________________________________________________________

    Has any short-term measure been taken to resolve problem? (e.g. erect barrier etc.)
    – describe: ________________________________________

    ______________________________________________________________

    ______________________________________________________________

    What further action is required? ___________________________________

    ______________________________________________________________

    ______________________________________________________________

    Signed: ______________________________ Dated: __/__/__

    Completed by manager

    Action taken to rectify problem: ____________________________________

    ______________________________________________________________

    ______________________________________________________________

    Action completed by: Date: __/__/__

    Managers Signature: _________________________ Date: __/__/__

    Copy of form returned to person(s) raising issue: Yes □

    Monitoring that control measure effective: Yes □ Date: __/__/__

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