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HAZARD REPORT (Sample)

Area/Locality of hazard

Date

Name.
(Name of person preparing report)

DESCRIPTION OF HAZARD (Include area and task involved, any equipment, tools, people
involved. Use sketches if necessary.)

POSSIBLE REMEDIES (List any suggestions you may have for reducing or eliminating the
problem, e.g. re-design mechanical devices, procedures, training, maintenance work, etc.)

To be submitted to the Manager

Signed.......

ACTION TAKEN

Date..
Manager..

CONTROL IMPLEMENTED & EVALUTATED

Date.
Manager.