C06 - HSW Hazard & Risk Report Form
INITIAL ASSESSMENT completed by person identifying a hazard / risk that is not being managed to mitigate the risk
Name of person reporting hazard
*
First Name
Last Name
Location of hazard
*
Date of observation
*
-
Month
-
Day
Year
Date
Time of observation
*
Hour Minutes
AM
PM
AM/PM Option
Description of hazard and potential risk consequence
*
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Description of any immediate action taken to reduce risk
Please advise the Duty Coach or other person on-site responsible. If you can remove or neutralise the hazard safely, please do so.
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Recommendations to control the hazard / risk
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Thank you for your submission!
Health and safety is the responsibility of us all.
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Should be Empty: