The Hazard Report Form is a crucial workplace safety document used across Canadian jurisdictions to comply with federal and provincial occupational health and safety requirements. This form should be used whenever an employee identifies a potential or actual hazard in the workplace, serving as an official record of the hazard identification, assessment, and response process. The document includes essential information such as hazard details, risk level, immediate actions taken, and witness accounts, while incorporating requirements from relevant Canadian legislation including the Canada Labour Code and provincial safety regulations. The form is designed to facilitate prompt reporting and effective response to workplace hazards, supporting organizational safety management systems and regulatory compliance.
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1. Report Identification: Unique report ID, date and time of report, location of hazard
2. Reporter Information: Name, position, contact details, and department of person reporting the hazard
3. Hazard Description: Detailed description of the hazard, including type of hazard and current status
4. Risk Assessment: Immediate risk level assessment (Low/Medium/High) and potential consequences
5. Immediate Actions Taken: Description of any immediate actions taken to control or minimize the hazard
6. Witnesses: Names and contact information of any witnesses to the hazard
7. Supervisor Notification: Details of when and how the supervisor was notified of the hazard
8. Authorization: Signature sections for the reporter and receiving supervisor
1. Environmental Impact: Section for describing potential environmental impacts when the hazard involves environmental risks
2. Chemical/WHMIS Information: Additional details required when the hazard involves hazardous materials or chemicals
3. Equipment Details: Specific section for equipment-related hazards including make, model, and serial numbers
4. Injury Information: Section to be completed if the hazard has resulted in any injuries
5. Photos/Diagrams: Space for attaching or including visual documentation of the hazard
6. Previous Related Incidents: Section for recording any previous similar incidents or hazards in the same area
1. Risk Matrix: Standard risk assessment matrix for determining hazard severity and probability
2. Hazard Classification Guide: Reference guide for classifying different types of hazards
3. Emergency Contact List: List of relevant emergency contacts and response procedures
4. Follow-up Action Form: Template for documenting corrective actions and their implementation
5. Investigation Checklist: Checklist for conducting detailed hazard investigations when required
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