Hazard Identification Report Form

Hazard/Risk or Near Miss Details

Date
Risk rate:
Does any process/procedure exist for this hazard/risk/near miss?
Is the risk acceptable?
Is the existing process/procedure

Corrective Actions (CA)

CA Deadline Date
CA Status:
Outcomes:

Sign Off

NDIS consultation required?
If yes; has NDIS been contacted?
If yes, date of NDIS consultation.
Date / Time