Tickit on Demand

Hazard Identification Form

Any person can identify a hazard or potential hazard in the workplace by completing the following Hazard Identification Form. Hazards identified should be reported to a Manager or Health and Safety Representative as per the Navitas Hazard Reporting and Workplace Inspection Procedure.

Your Name^*

Your Email^*

Your phone number^*

Date Occurred^*

Location where incident occurred^*

Hazard Identification

Hazard or Problem^*

Describe the hazard or problem in as much detail as possible. You have the option to attach evidence (Photo) after submitting the form.

What is the Risk?

Describe how someone could be injured or how damage or loss could occur?

Suggested Control

What are the suggested actions to mitigate remove or minimize the risks?

Suggested manager to action

Managers email address: