Hazard Form - IDCHAZARD REPORT FORMBrief Description of Hazard/Health and Safety IssueWhere is the hazard located in the workplace?Time / Date Hazard IdentifiedRecommended Actions to fix Hazard/IssueRecommended completion date:PLEASE NOTE: This report does not imply that all other conditions and work practices are acceptable.Health and Safety Representative (HSR) Name:Signature Sign Here DateReceived by the PCBU or Health and Safety Advisor Name:Signature Sign Here DateHow did the PCBU address the Hazard/Issue?Do you Consider the Issue fixed? Yes NoCompleted on:WHSR Signature: Sign Here Submit Form
