Hazard Identification Form

This Hazard Identification Form is used to identify and reduce workplace hazards. It includes a list of possible actions to reduce risk, hazards, associated risks, and guidance on how to prevent or reduce the identified risks. The form is designed for large organizations and can be completed for each workplace area or group. It also includes a checklist for assessors to ensure all requirements are met.

Hazard Identification Form
(Complete one form per workplace area or group for large organisations. Refer to Learner Guide 2 for assistance)
Workplace area
or grouping:
Awesome Landscape
office
Name of person
completing
form:
Name of the student Date: 15/05/19
Hazard
Ref No Hazard Risk(s) associated with
hazard
Who/what is at
risk
Possible actions to reduce
risk
Guidance: Specify action/s
that will prevent or reduce the
possibility of the identified
risk from occurring or
becoming an incident.
1
The entrance gate
of the kitchen is blocked
by a Large trolley rack
Employee can be injured
by stuck by the trolley rack or
can be fall on ground
All
employees who
works in the
kitchen
Removing the object
from the passage and
placing it in a suitable ad
safe position.
2
Displaced floor made
the floor uneven and
risky for walking
Anyone can trip and fall due
by stuck his or her foot within
uneven plane
Anyone who walks
through that
position.
The gap between two
carpet should be filled by
any soft material or hazard
sign is needed
3 Emergency Exit
food is blocked by a
dangerously placed
metallic equipment
During emergency
additional injuries can cause
by this obstacle
All
employees and the
visitors
Removing the metallic
objet from the front of the
emergency gate and placing
the object in a safe and

Hazard
Ref No Hazard Risk(s) associated with
hazard
Who/what is at
risk
Possible actions to reduce
risk
Guidance: Specify action/s
that will prevent or reduce the
possibility of the identified
risk from occurring or
becoming an incident.
secured place.
4
A large tray is
placed over the top of a
furniture dangerously
beside the boardroom
The half hanging tray
can fall on head and can
cause serious injury
Employees of
the storage areas
or any passerby
Removing the tray
from the top of the
furniture and placing it in a
flat ground to avoid
accident
5
The unassembled
furniture are placed in
scattered way Anyone can trip off or injured
by sharp edge of the materials
Anyone who
enters in the
manager’s room.
The scattered
furniture should be
properly assembled and
placed safely.
6
Gap in ceiling
layer is making the
ceiling plate lose and
dangerous
The misplaced ceiling plate
can be fall on anyone’s head
causing physical injury
Anyone who walks
beneath that
position.
The plate should be placed
properly
7
Electrical wires
are scattered over the
floor dangerously Anyone can trip over causing
physical injury or can
experience electrical shock
Anyone who tries
to stand beside the
window or walk
through that place
The wires will be
concealed in a safe way

Hazard
Ref No Hazard Risk(s) associated with
hazard
Who/what is at
risk
Possible actions to reduce
risk
Guidance: Specify action/s
that will prevent or reduce the
possibility of the identified
risk from occurring or
becoming an incident.
8
The signboard is placed
bellow the safe height
Anyone can be injured from
the sharp age of the sign
board
Physical Injury,
Head Injury,
Putin the signboard at a
safe height
9
A broken door is placed on
the wall
The door can fall on any office
employee during work hours
Physical Injury,
Head Injury, stuck
by hazard
Removing the door from the
current place and placing
the object in a safe and
secured place.
10
A metal ladder is placed
in front of store room
entrance
Anyone can trip off or injured
by sharp edge of the materials
Physical Injury,
Head Injury, stuck
by hazard
Removing the metal ladder
from the current place and
placing the object in a safe
and secured place.

FOR THE ASSESSOR:
Checklist – Does the hazard identification form meet
the following requirements?
Y/N
1. A specific work area has been defined (may be entire
business if it is a small business, part of a business
area, a department of a business, or an external site
where the business operates).
2. At least ten specific hazards must be identified.
3. Some of these hazards must be from a previous
assessment done in the work area.
4. All columns have been filled in with specific answers for
each hazard.