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  • Hazard Report Form

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    Mana Jeff
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    This hazard report form documents a reported hazard at a work site. It records the date, names and positions of the person reporting the hazard and person reported to, as well as the site location and type of hazard (incident, near miss, workplace hazard, or hazardous workplace). The form also includes sections for describing the hazard and recommended actions, and signatures.

    Original Description:

    Hazard reporting form for reporting hazards by KERACS Ltd.

    Original Title

    Hazard report form

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    This hazard report form documents a reported hazard at a work site. It records the date, names and positions of the person reporting the hazard and person reported to, as well as the site location and type of hazard (incident, near miss, workplace hazard, or hazardous workplace). The form also includes sections for describing the hazard and recommended actions, and signatures.

    Copyright:

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

    Hazard Report Form

    Uploaded by

    Mana Jeff
    This hazard report form documents a reported hazard at a work site. It records the date, names and positions of the person reporting the hazard and person reported to, as well as the site location and type of hazard (incident, near miss, workplace hazard, or hazardous workplace). The form also includes sections for describing the hazard and recommended actions, and signatures.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    HARZARD REPORT FORM

    Date:………………………………. Hazard Report Number:………………………..

    Reported by:

    Name:…………………………………………………………………………Position:…………………………………………………………

    Reported to:

    Name:…………………………………………………………………………Position:……………………………………………………….

    Site Location:……………………………………………………………….

    Subject:

    Incident Near miss Workplace hazard Hazardous workplace

    Description of Hazard:

    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    …………………………………………………………………………………………………………………………………………………………….
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………

    What needs to be done?

    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    …………………………………………………………………………………………………………………………………………………………….
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………………………

    Signature:……………………………………………… Date:……………………………………….

    Copy given to:

    Manager: …..…………………………………………………………….(Signature)

    Communication meeting: ………………………………………………………………….(Signature)

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