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Hazard / Risk Observation Card

Quick field hazard capture: if you see something, say something

Company logo

PAGE 1 OF 2

Observer Details

Observer name

Date

Time

Shift

Location / area

Site / project

Hazard Type

Housekeeping Environmental Behavioural Equipment / plant PPE Access / egress Chemical Electrical Working at heights Other: _______________

Hazard Description: What Did You Observe?

Risk Rating (Likelihood × Consequence)

Likelihood

Almost certain Likely Possible Unlikely Rare

Consequence

Insignificant Minor Moderate Major Catastrophic

Overall risk level

Critical High Medium Low

Immediate Action Taken

Hazard Observation Card - Page 2 of 2

Date

Observer

Can the Hazard Be Fixed Now?

Can the hazard be fixed immediately?

Yes - fixed on the spot No - reported to: _______________

Photos / Sketches

Attach photos or draw a sketch of the hazard location. If using paper, staple photos to this card.

Follow-up Action Required

#	Action required	Responsible person	Due date	Status
1
2
3

Declaration

I declare that I have observed the hazard described in this card and reported it accurately. Any immediate actions taken have been noted. I understand that hazard reporting is a positive safety behaviour and no blame is attributed to the observer.

Observer Sign-off

Signature

Print name

Date & time

Supervisor Acknowledgement

Signature

Print name

Date