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AHazardreviewformmaybecompletedeitheronlineandemailedtosupervisor,orinprintedformand
giventosupervisor
Itisvitalthattheformbecompletedassoonaspossible,withintwentyfourhoursaftertheincident
Theformmustbecompletedby:
Eachemployeeinvolved
Eachwitnesstotheincident
Supervisorondutyatthetimeoftheincident
Eachformmustbesignedwithdateandtimeofincidentandthedateandtimethattheformwasfiled
Indicateiftheformisbeingfilledoutbyanemployeethatwasinvolvedorbyawitness
Includeathoroughexplanationoftheincidentincludingdateandtimeofincidentandlocation.Please
includeanypertinentinformationthatmayhavecontributedtotheincident
Explaintheprocedurestakentocontaintheincident
Giveadetailedlistofanyinjuriesorpossibleinjuriesandanymedicalattentionthatwassought
Provideanyideasforhowtoimprovepoliciesandprocedurestoavoidfutureincidents
Ifmorespaceisneeded,attachadditionalsheetsasneeded