Hazard Report Form

Safety Spectrum

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Safety Spectrum

Hazard Report Form ID 553

Hazard Details Details

Workplace Hazard Report 553

Select the type of hazard to be reported and fill out the report accordingly.

Want to finish this form later? Use this link: https://uw.safety.uwaterloo.ca/public_hazard_form?hazard_code=t31269610lz05l4i4uh22uii

Hazard Details

Hazard Report Title

Hazard Category

Hazard Type

Area

Describe Other Potential Effect(s)

An odour issue was identified. How would you describe the odour?

Description of Hazard

Perceived Risk of Hazard (potential for injury or property damage)

Very Low Low Medium High

Outdoor Temperature

Indoor Temperature

Local Weather observed at the time of the concern

Yes No

Actions Taken

Describe any immediate action(s) taken to correct the hazard , if any.

Suggested Corrective Action(s)

Documentation

Do you have pictures or documents that relate to this issue?

Yes No

Upload Files

(maximum 30 MB per file, JPEG, GIF, PNG, PDF, DOC, DOCx, VIDEO, AUDIO ONLY)

Drop files here or click to upload.

Date and Time

Date Issue Identified

Time Issue Identified

Location

Where is this issue occurring?

Issue Location

GPS Coordinates

Select on Map / Search For Address GPS Location Not Selected

Location Type

Description of Issue Location

Department Responsible For Hazard Area

People

Name of Person Who Reported Hazard

Phone

Submit Report

Click Here To Submit Report

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