Incident Report Forms >>
Published 12/16/2023

HAZARD REPORT EXAMPLE: SAMPLE HAZARD REPORT FORM

Here we showcase the fields you might include in your Hazard Report form. This template is commonly part of an incident management process where a hazard report is logged after an incident for identifying the hazard that may have led to the incident and what controls need to be put in place around that.

- Date reported
- Site
- Area
- Time
- Exact location
- Briefly describe this hazard
- Hazard Identification
- How Hazard Identified
- How was this Hazard Identified
- Risk Assessment
- Likelihood
- Consequence
- Risk Rating
- Further Investigation
- Please identify and explain the underlying cause of this hazard or incident
- Causes
- Other caus
es - Risk Controls
- Person Responsible
- By When
- Hierarchy Level
- Has it been implemented
- Additional Risk Controls
- Additional responsibility
- Additional By When
- Additional Hierarchy Level
- Has they been implemented
- If you have not eliminated the risk please explain why
- Authorisations and Status
- Name of person who initially completed this report
- Position
- What date was the final risk control implemented
- Who authorised that this has been completed
- Have all Risk Controls been monitored and deemed to be effective
- If the risk controls were not effective please provide detail about further action or status of incident
- Is the risk now at an acceptable level
- What is the status of this Incident
- Photo

In any workplace environment, it's important to have safety protocols in place, and one of those is the use of a hazard report form. A hazard report form is designed to document incidents, injuries or fatalities that could lead to potential dangers within the environment. This document complements existing policies and procedures related to health and safety so that employers can take measures necessary to minimize risks associated with working conditions.

Hazard report forms provide an effective way for employers to identify problems before they occur or get out of hand. These documents also enable employees to voice their concerns without fear of retribution from management or co-workers. Furthermore, these forms provide detailed information pertaining specific incidents which allow employers not only address issues but also develop strategies on how further prevent them from occurring again in the future.

CREATE YOUR OWN HAZARD REPORT FORM

Move away from paper based forms and move to mobile hazard reports. Ensure everyone has the ability to report a hazard in your workplace. Do your staff and contractors have the ability to directly do this in their own words right now?
If you need something ready to go, we've also got a library of templates too!

HAZARD REPORTING PLATFORM

Try out the demo above and see how your hazard incident report form process looks via our dedicated hazard reporting platform.

View Hazard Templates, Forms and Examples