Hazard Reporting Form

This form should be used to report and record a hazardous work condition or practice identified on campus property or within any campus building.

An effective health and safety management system relies on hazard identification and reporting as part of normal work practices. Workers should be encouraged to report hazardous and unsafe work conditions to promote consultation on safety concerns at the workplace and remediation of the issue.

If you are unsure how to escalate hazards, please refer to the Internal Responsibility System (IRS)

Who should complete this form?

This form should be completed by any worker who identifies an unsafe work condition or act in the course of their work. All health and safety concerns should be brought to the attention of the immediate supervisor in charge of the workplace or the worker.

How will this form be used

All completed hazard report forms will be reviewed by the Health and Safety Office to identify corrective actions, improvements or proactive initiatives required to address and correct the hazard or safety concern.

How to complete this form

This form contains three sections:

Part I: Hazard Description – this section should be completed to specifically describe the identified safety hazard or issue. You should include the date that the hazard/condition was observed, the location of the hazard, the detailed description of the hazard or safety issue, and the assessed risk class.

Part II: Recommendations – this section should be completed to describe recommended remedial action.

Part III: Corrective Actions – this section should be completed to record any actual remedial or corrective actions taken to address the concern and make the area or condition safe.