Hazard • C3 Church Auckland

Hazard/Risk Identifcation Report

(Completed by person identifying hazard)

First Name

Last Name

Email Address

Mobile Number

Location of hazard/risk

If you selected 'Other', please clarify

Date of incident/accident

Describe the hazard/risk

Tip: (Please give as much details as possible)

Has the hazard/risk been controlled or minimised? If yes, then how.

Was a staff member/location Pastor notified?

Form completed by (Full Name):

Date person completed form