Sheforce Hazard Report Form

Your details

Tell us who is making the report.

Date of report *Reported by *Job title *Department or team *Contact information *

Hazard details

Describe the hazard and where it is located.

Hazard description and location *

Hazard category

Physical HazardSlippery floors, faulty equipment or unsafe accessChemical HazardHazardous substances or chemical spillsBiological HazardMould or infectious materialsErgonomic HazardPoor workstation setup or repetitive tasksPsychosocial HazardWorkplace stress, bullying or inappropriate behaviourElectrical HazardExposed wires or faulty electrical equipmentFire HazardBlocked fire exits or flammable materialsOtherAnother type of hazard

Other category details

Hazard severity

LowMinimal risk of harm or injuryModerateSome risk of harm or injury, but unlikely to cause severe consequencesHighSignificant risk of harm or injury that could cause serious consequencesCriticalImmediate action is required to prevent severe harm or injury

Hazard probability

RareUnlikely to occurOccasionalMay occur in certain situationsFrequentLikely to occur regularlyVery FrequentHighly likely to occur frequently

Additional information

Include anything that will help Sheforce respond appropriately.

Contributing factors and potential impact *

Date of occurrence, if applicableApproximate time

Witnesses, if anyImmediate actions taken, if anyRecommendations for mitigationHazard photo, if availableOptional. JPEG, PNG, WebP or HEIC, maximum 10 MB. Do not compromise your safety to take a photo.

Declaration

Confirm the report before submitting.

I confirm that the information provided is accurate to the best of my knowledge.

Reported by *Date *

Submitting this form sends the report to compliance@sheforce.com.au.