Hazard Report
Date Time
am pmLocation of hazard
Address
Person reporting hazard Title Mr Mrs Miss
Address
Tel:
Person who first became aware of the hazard if not above:
Details of Hazard (continue on back/ additional sheets if needed)
Action taken
(continue on back / additional sheets if needed)
Other people informed
1. Address How/ When
2. Address How/ When
Further actions required
(continue on back/ additional sheets if needed)
Firmly attach any additional sheets Number of additional sheets:____
Date of report Signed