We all play a part in helping with the safety with those in our care and for those around us.

Use this form to report a hazard. Ideally if you can do steps to remove the hazard and then fill out this form within 12 hours so that we can either escalate it, investigate, or record that it happened.

For a paper copy please press the button below. Please either give it to your team leader or director, or post it to:

41 Railway Avenue Strathpine QLD 4500

Hazard Paper Form

Hazard Report

To be completed within 12 hours of the Hazard being observed.

Please take a few pictures of the incident and email them to:

hazards@buenavistaservices.co

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Step 1: Report the Hazard

Name

Name of person reporting the hazard

First Name

Last Name

Date Reported

Note: Date is American - MM DD YYYY

MM

DD

YYYY

Time reported

Hour

Minute

Second

Email

Phone Number

Number of person reporting hazard

Where is the hazard?

Location/Address of hazard

Describe the Hazard

Describe what the hazard is.

Step 2. Assess the Risk

Risk Ranking

Use the above image and choose which number best represents the risk level. i.e. its unlikely to happen and it would have minor consequences = 1.

Risk Level 1

Risk Level 2

Risk Level 3

Risk Level 4

Hierarchy of Controls

1. Eliminate the hazard 2. Substitute with something that is less hazardous 3. Isolate the hazard from people 4. Engineering (guarding etc) 5. Administration (training, procedures) 6. Personal Protective Equipment (PPE)

Control the Hazard

Using the Hierarchy of Controls, write down what you have put in place to reduce the risk of the hazard.

Make the area safe (if able to do so), advise other staff members and notify management.

Hazards

Hazard Report