Hazard & Opportunity Report Form
 
A simple form that lets anyone in your business report a hazard, near miss, unsafe work practice or improvement idea, and gives supervisors a clear way to assess it, act on it and close it out.
 
What's included
Section 1 for the person reporting: what they saw, what they did straight away and how it could be fixed
Section 2 for the supervisor: a 5 x 5 risk matrix, risk rating and the control chosen using the hierarchy of controls
Action required, person responsible and due date
Section 3 close-out, including feedback to the person who reported it
A one-page instruction sheet with step-by-step guidance and tips
 
When to use it
A worker spots something that could hurt someone
Something nearly went wrong
A task is being done in an unsafe way
Someone has an idea to make a job safer
 
Make it yours
Fully editable in Microsoft Word. Add your logo, change any item to suit your workplace, and print it or use it on screen. Review it with your workers before you start using it.