Hazard Form
Create your Hazard number
e.g. 06JAN23RF - this means that this hazard was identified on the 6th of January 2023 by Rose Farfalla
REPORTING A HAZARD
What was the date when the hazard occurred?
Where is the hazard?
e.g. participants house, rosebud cafe
What is the hazard?
Upload a photo, if you can.
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ACCESS THE RISK
Think about what sort of injury the hazard could cause and how likely it is to occur. Select the risk likeliness:
Highly Unlikely
Unlikely
Likely
Highly Likely
Fatality
Highly Unlikely
Unlikely
Likely
Highly Likely
Major Injury
Highly Unlikely
Unlikely
Likely
Highly Likely
Minor Injury
Highly Unlikely
Unlikely
Likely
Highly Likely
Negligible Injury
Highly Unlikely
Unlikely
Likely
Highly Likely
HAZARD CONTROL
List what you have put in place to reduce the risk of the hazard, if any.
Have you reported this to management? And if so, who?
Reporting Persons Signature
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Reporting Persons Name
Date Signed
A copy of this will be emailed to you. Email:
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