Hazard report form template
A one-page form for reporting a hazard before it becomes an incident: what was found, where, who could be harmed, what was done straight away, and the corrective actions through to close-out. Word and PDF, emailed to you.
Word and PDF. Emailed to you, no sales call.
What it is for
A hazard report is how a worker tells the business about something that could hurt someone before it does: a missing guard, a damaged ladder, a spill, an unmarked trench. The form only works if it is quick to fill in and somebody acts on it, which is why this one is a single page with the close-out at the bottom.
The reporter fills in the top half: who, when, where, what, who could be harmed, and what they did straight away. The supervisor rates it, records the corrective actions with an owner and a due date, and signs it off when the hazard is gone.
What is in the template
- Reporter details: name, role, company, date, time and the exact location.
- The hazard: description, how it was identified, who could be harmed and the likely harm.
- Immediate action taken and an initial risk rating.
- Who it was reported to and when.
- Corrective actions with a responsible person, a due date and a completed date, then close-out signatures.
How to use it well
- Make the form easy to find and quick to fill in. A hazard report that takes fifteen minutes will not get written.
- Rate it straight away so the supervisor knows whether it is a today problem or a this-month problem.
- Close the loop with the reporter. Nothing kills reporting faster than silence after the first one.
Further reading
- Identify, assess and control hazards, Safe Work Australia
- Model Code of Practice: How to manage work health and safety risks, Safe Work Australia
Before you use it
This template is a general starting point only. It is not advice, it was not prepared for your workplace, and it does not take account of your sites, your work or the requirements that apply to you. You are responsible for checking it, adapting it and deciding whether it is suitable before you use it. AREESA accepts no responsibility or liability for any loss, injury or damage arising from its use.
When the paper version stops scaling
In AREESA a hazard report is a form on the worker's phone with a photo attached, a rule that emails the right person the moment it is submitted, and a hazard register behind it that shows every open hazard by risk level in your metrics.
Questions
What is the difference between a hazard and an incident?
A hazard is something that could cause harm. An incident is when harm, or a near miss, has already happened. Report hazards on this form and incidents on the incident report form.
Who should fill in a hazard report?
Anyone who spots the hazard. The reporter fills in the top half; a supervisor takes it from the risk rating down.
What happens after the form is filled in?
The supervisor rates it, decides the corrective actions, gives each one an owner and a date, and signs it off when the hazard is gone. Keep the completed form; it is the record that the hazard was found and fixed.
Should hazard reports go into a register?
Yes. A hazard register is the list of every reported hazard with its rating and status. This form is one entry; the register is where you see them all together.
See the hazard report form running in AREESA.
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