Hazard Report Form

Use this form to report a potential Hazard. A Hazard is defined as something that has the potential to cause harm to people, property or the reputation of Sunnyside Australia

Your Name :(Required)

Full Name

Phone(Required)

Your Relationship to Sunnyside Australia(Required)

Participant

Friend

Service Provider

Authorised Representative

Other

Other (please detail)(Required)

Address / Location of Hazard(Required)

Street Address Suburb State Post Code

Hazard Type :

Plant / Equipment

Substance / Asbestos

Biological / Waste

Manual Task / Bending / Lifting

Environment / Buildings

Energy / Electricity

Psychosocial

Other

Has the Hazard been reported previously?(Required)

Yes

No

If yes, who to?(Required)

When?(Required)

DD slash MM slash YYYY

Other (please detail)(Required)

Please provide a full description of the Hazard :(Required)

Has any person sustained an injury from this Hazard?(Required)

Yes

No

If yes, please give details :(Required)

Select Risk Rating :(Required)

HIGH RISK

Medium Risk

Low Risk

Recommended action that could be taken to eliminate or treat the Hazard?(Required)

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