Hazard Report Form Template – Australia

The Hazard Report Form Template – Australia comes in multiple formats, including PDF, Word, and Google Docs. Each version is designed to be both editable and printable, ensuring a user-friendly experience.

Template – (Open)

Complete Template Online

Sample

Hazard Report Form Template – Australia

Editable | Printable

(PDF – 1) (PDF – 2)

Complete Template Online

1. Reporter’s Information



2. Date of Report

3. Location of Hazard

4. Description of Hazard

5. Possible Consequences

6. Immediate Action Taken

7. Suggested Preventative Measures

8. Witnesses (if any)



9. Follow-Up Actions Required

10. Declaration


PDF

WORD

Examples

Hazard Report Form Template – Australia (1)
Company Name:
[Company Name]
Location:
[Location Address]
Reported By:
[Employee Name]
[Employee ID]
[Department]
Date of Report:
[Report Date]
Hazard Description:
A detailed description of the hazard, including the specific location, type of hazard (e.g., chemical, physical, biological), and any immediate risks associated with it.
Potential Consequences:
An outline of possible outcomes resulting from exposure to or involvement with the hazard, such as injury, health risks, or property damage.
Immediate Actions Taken:
Document any measures already taken to address the hazard, like evacuation, isolation of the hazard, or first aid provisions.
Recommended Actions:
Suggestions on how to mitigate or eliminate the hazard, including long-term solutions and responsible personnel for implementation.
Follow-up Required:
Specify if further investigation or review is needed and suggest a timeline for follow-up actions.
Signed:
[Reporter’s Signature]
[Date]
Hazard Report Form Template – Australia (2)
Department:
[Department]
Reported By:
[Employee Name]
[Employee ID]
Date of Report:
[Report Date]
Hazard Type:
[Type of Hazard (e.g., slip hazard, chemical spill, equipment malfunction)]
Specific Location:
[Exact Location of Hazard]
Description:
A comprehensive description of the hazard identifying all related conditions and risks involved.
Severity of Hazard:
Rate the severity (e.g., minor, moderate, major) and provide justification for the rating.
Control Measures in place:
List existing control measures and their effectiveness regarding the reported hazard.
Corrective Actions Required:
Outline any needed corrective actions and responsible parties to address the hazard effectively.
Follow-up Actions:
Indicate follow-up requirements, including dates for further assessments or reviews.
Signed:
[Reporter’s Signature]
[Date]

Printable

PDF – 1 PDF – 2

Hazard Report Form Template - Australia