Hazard Report Form
WHS Representative: Billie Marsden
Phone: 0410 234 567
(1) Selected Hazard/Health and Safety Issues:
- The new staff member who has not attended WHS training.
- The trolley to carry heavy stock was not working.
- Stock stored incorrectly above shoulder height.
(2) Location of Hazard in the Workplace:
Remote storeroom
(3) Date and Time of Hazard:
Date: 01/02/2023
Time: 10:50 am
(4) Selected Actions to Ensure Workplace Health and Safety:
- Complete "Safe handling techniques" training.
- Install adequate lighting.
- Ensure heavy stock is stored below shoulder height.
Completed by: [Your Name / Position]
Phone: [Your Phone Number / Position or Department]
WHS Rep: Billie Marsden
Phone: 0410 234 567
Please ensure that this report is submitted promptly to address the identified hazards.