Hazard/Incident Report Form

23/1/2021 3845nr5
Date: Hazard Report Number:

Reported By:
John Kalmar
Name: Position: Assistant director

Reported To:
Martha Peter Manager
Name: Position:
Workshops
Site location:

Subject:

Incident Near Miss Workplace Hazard Hazardous Work Practice

Description of Hazard or Incident:

Joseph leery slipped and fall at the reception area. He got symptoms of light-headedness, nausea
and dizziness. There are no acute injuries but there are possible long-term effects because the spine
was affected. He got minor bruises and abrasion on his harm. First aid was provide and rushed to
hospital.

What needs to be done?

Improve lighting; avoid leaks from appliances or pipes; provide sufficient drainage to prevent steps as
pollutants from pooling; apply floor treatments to increase slip resistance; Mark the edges of the
well as any changes in floor height. Implement good housekeeping practices such as direct access
ways, quick spill clean-up, signs or barricades for wet or slippery areas, and training and supervision.

Signature: Date:

Copy given to:

Manager: (Signature)

Communication Meeting: (Signature)

This study source was downloaded by 100000834106079 from CourseHero.com on 06-05-2022 07:31:29 GMT -05:00

https://www.coursehero.com/file/136046507/Hazard-Incident-Report-Formdoc/
This study source was downloaded by 100000834106079 from CourseHero.com on 06-05-2022 07:31:29 GMT -05:00

https://www.coursehero.com/file/136046507/Hazard-Incident-Report-Formdoc/
 This study source was downloaded by 100000834106079 from CourseHero.com on 06-05-2022 07:31:29 GMT -05:00

https://www.coursehero.com/file/136046507/Hazard-Incident-Report-Formdoc/
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