Hazard ID Report

Report Identified Hazards to Protect Our Team

⚠️ HAZARD IDENTIFICATION

👤 Submitter Information

Your Name *

Email Address

Company *

Date *

Location *

⚠️ Hazard Details

What is a Hazard? Any condition, behavior, or situation that has the potential to cause injury, illness, damage, or environmental harm.

Identified Hazard *

Was this a Near Miss? *

Yes - An incident almost occurredNo - Potential hazard identified

📊 Threat Level Assessment

Threat Level *

🟢

LOW

🟡

MEDIUM

🟠

HIGH

🔴

CRITICAL

⚡ SIF Potential Assessment

STKY = Stuff That Kills You

This assessment identifies whether this hazard involves high-energy sources with Serious Injury or Fatality (SIF) potential.

Could this hazard involve HIGH ENERGY? *

Yes - Could cause serious harm or deathNo - Low energy situation

High energy = gravity (falls, drops), motion (vehicles, equipment), electrical, pressure, chemical, temperature extremes

🔧 Corrective Actions

Corrective Action Already Taken

Is Additional Action Necessary? *

YesNo

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