In the realm of occupational safety and health, the Hazard Report form stands as a crucial tool, designed to meticulously record and address potential threats in the workplace. At its core, this document captures the essence of a proactive approach towards preventing accidents and ensuring a safe work environment. Through the lens of a specific case involving the removal and loss of a guard from a brake press during maintenance, the importance of this documentation becomes abundantly clear. The form meticulously outlines who identified the hazard, the precise nature of the incident, immediate corrective actions taken, and further measures deemed necessary to prevent future occurrences. It provides a systematic way to halt the use of hazardous equipment, outlines plans for rectification such as the fabrication of a new guard, and schedules preventive measures — from staff training to enhanced inspection protocols. Significantly, it also details the managerial follow-up, sealing the loop on accountability and continuous safety improvement. This structured report not only facilitates immediate response but also fosters an ongoing culture of safety awareness and improvement, framed by the participation of both supervisors and managers, exemplified by signatures from Dave Sharpe and MR FABIO METTALL. The utilization of such a form delineates a roadmap for navigating the complexities of workplace safety, ensuring every identified risk is not merely recorded but is acted upon with a clear, comprehensive strategy aimed at safeguarding the well-being of all employees.
Question | Answer |
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Form Name | Hazard Report Form |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | hazard reporting form template, hazard incident report example, example of hazard report, hazard report form sample |
HAZARD/INCIDENT REPORT FORM
To be completed by supervisor
1. Who reported the hazard/incident? Ahmed
Time: |
9:30am |
Date: |
Tue 26th Aug 2006 |
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2.What is the hazard/incident? Guard taken off brake press when it was undergoing maintenance and guard has been lost.
3.What has been done to rectify the hazard/incident? Machine use stopped (has been tagged out)
New guard being made and will be fitted once complete
Time: |
8:00am |
Date: |
Thur 28th Aug 2006 |
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4.What further action needs to be taken? 1. Tool Box talk - 17 Oct
2.Machine maintenance safe work procedures to be written up and displayed
3.Leading hands to undertake weekly inspection program (incl all guards)
4.Induction training for all new employees to include machine guarding
5. Referred to manager/owner for information or action (date) |
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Thur 28th 2006 |
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Signed: |
Dave Sharpe |
Date: |
28/8/06 |
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To be completed by manager/owner
6. Action taken by manager/owner Undertake regular review of inspection
sheets to ensure follow up and to identify emerging issues.
Signed: |
MR FABIO METTALL |
Date: |
01/9/06 |
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