Report Hazard

If you identify a hazard or unsafe condition on site, please report it using this form so it can be addressed as soon as possible. Hazards should be reported even if no injury has occurred.

What Emerald Building Services site are you working on?

Type of Hazard

Upload a photo of the hazard (if possible)

Please make sure the image is clear

Click or Drag and Drop to upload

JPG, PNG (max 5mb)

I cannot take a photo of the hazard right now

Description of Hazard

Risk Level

Date and Time Hazard Identified

Day

Month

Year

Hour

:

Minute

Immediate Risk to Workers

Yes No

Action Taken (if any)

Hazard Status

Area made safe Temporary control in place Reported to supervisor for action No action taken yet

Supervisor Notified

Yes No Not yet

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