Hazard Notification Form



Nature of hazard

What is the hazard? What is the risk it presents to the safety and well-being of people?











Where is the hazard?





When was the hazard identified (i.e. the date and time)?

Immediate action

Was anything done immediately to remove, isolate or minimise the hazard (if yes, state what):









Is this hazard considered significant and in need of urgent action?  




Name of person identifying hazard:  


Name of person notified of hazard:  


Date today:  



If you are a member of the congregation or visitor filling out this form, please give it to the Church Office, the Pastor or Associate Pastor, one of the Deacons, or a member of the Health & Safety Committee.

If there was an accident or incident because of the hazard, please also complete an accident notification form (or ensure one is completed).