Hazard Report Form
Location/Department details:
Location/Department *
Address
State
Person reporting the incident:
Reporter Name
*
Reporter Email
*
Reporter Phone
*
Hazard details
Type of Hazard * (multiple selections, click out of the selection area to continue)
Hazard location
*
What did you see?
*
What did you do?
*
Upload Attachments
Risk matrix:
Select the likelihood, consequence category and severity to determine the level of risk
Likelihood Rating *
Consequence Category *
Submit
