Hazard Report

Users of the Church site are required to use this to keep a record of any identified health or safety issues reported by workers and users of Church facilities. This will help to maintain and improve safety in the Church by identifying hazards, risks, faulty equipment, unsafe practices etc.

First Name *

Date of Report Submission *

Tip: Date you are submitting this form

Last Name *

Who reported the issue? *

Time this person reported this *

Who was the issue reported to? *

Time the issue was reported? *

Date Issue was reported *

What is the Hazard/risk? Location of hazard/risk? *

What is its priority? *

Tip: Assess the priority of the health or safety issue by identifying its most likely impact/consequence on workers and the chance of it actually happening.

Date for remedial action to fix issue? *

What has been done to rectify the health or safety issue? *

Date *

What further action needs to be taken? *

Tip: eg. Training, item removed, manual task, review of safe work procedures, training, etc.

By whom needs to complete these actions? *