Hazard report form template

What’s inside

Five pages, and only the first four need the worker.

• Hazard details: location, date and time, and a plain description of what it is and who it could affect
• Risk rating: how likely harm is, and how severe it could be, with space to explain the call
• Contributing factors: equipment, training, work practices, time pressure, maintenance
• Suggested fixes, because the person doing the job usually knows the answer
• Manager section for corrective actions, with an action table showing who is doing what by when
• Sign-off from both the manager and the worker who raised it

Two things most hazard forms get wrong

Nobody tells the worker to stop. This one opens with it. If the hazard puts someone in immediate danger, stop the work and tell your supervisor. Do not wait for the form to be processed. Paperwork comes after people are safe.

The loop never closes. Most forms have the manager sign off and that is it. The person who reported the hazard never hears what happened, so next time they do not bother. This form has a second signature line for the worker, to confirm the hazard and the controls were actually discussed with them.

Fill it in on screen, or print it

The PDF is fully editable. Type into any field, tick the boxes, save it and email it. Risk ratings are proper radio buttons, so you get one answer per question, not three.

Signature lines are left blank for wet signing. Keep a blank master and fill a fresh one each time.

A template is a starting point

This is a solid, well-built form based on Australian WHS practice. It is not a hazard management system on its own.

A form only works if the reports get read, actioned and closed out. If hazard reports are going into a drawer at your place, the form is not the problem.

That is the part we help with. BWC Safety consultants each bring over 20 years of senior management experience across a wide range of industries.