Work Health & Safety Hazard Register Example

Work Health & Safety Hazard Register
Date
DayMonthYear
Date
Potential Hazard
Who is at risk
Other
Name of staff or family member at risk (if applicable)
Risk Ratings
Risk Rating 1: Potential to cause death, permanent disability to staff or extensive loss or damage to plant, equipment or materials
Risk Rating 2: Potential to cause serious injury to staff or other damage
Risk Rating 3: Potential to cause minor injury to staff or non-disruptive property damage
Risk Rating 4: Satisfactory
Risk Rating
Control Measures
1: Elimination of the hazard
2: Substitution i.e. replacing hazardous substance, machinery or work process with a non-hazardous or less hazardous one
3: Engineering Control i.e. by modifying tools and equipment
4: Administrative Control: i.e introducing work practices which eliminate or reduce risk
5: Personal Protection of staff by providing protective clothing and equipment where other measures are not practical
What control measures have been implemented?
What action has been taken?
Annual review date
MonthDayYear
Date
Comments
Name of person who submitted this form
First NameLast Name
Should be Empty: