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Hazard Report Form

Complete this form only if no injury has occurred.  If an injury has occurred, please complete the Confidential Incident/Injury report Form Part 1 & 2 by following this link

Hazard Details
Type of Hazard
Location of hazard
Description of Hazard
When was the hazard first observed
Preventative action taken?
 Yes
 No
Details of action taken

Person Reporting Hazard
Firstname
Surname
Telephone Number
Follow up required?
 Yes
 No
Are you
 
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