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Hazard report form

A simple form for reporting one workplace hazard: a trailing cable, a broken step, a blocked fire exit, a leaking container. Anyone can fill it in, with or without their name, in an office, school, kitchen, ward, warehouse or workshop. Say where it is, add a photo, say who could be hurt and what you did straight away. The manager then records what they found, the risk on your organisation's own scale, whether the risk assessment covers it, the actions with an owner and due date, and the feedback given to the person who reported it. An optional second part is a hazard identification walk-round: each area is checked for common workplace hazards. It is different from the safety observation report, which records one observation on a construction site, good or at risk.

For employees, supervisors, safety representatives and managers in any workplace who want hazards reported with a photo, dealt with and fed back, rather than lost in an email.

Notes for the UK (Management of Health and Safety at Work Regulations 1999, Safety Representatives and Safety Committees Regulations 1977, Employment Rights Act 1996) and the US (OSHA section 11(c), 29 CFR 1977.9 and 1904.36).

  • One hazard per report, with or without the reporter's name, place, GPS and photos
  • Who could be harmed, how often, and what was done straight away
  • The manager's finding, the risk on your own scale and the risk assessment check
  • Actions with an owner and due date, and the feedback given to the reporter
  • Optional hazard identification walk-round: twelve common workplace hazards checked area by area
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What is a hazard report form?

A hazard report is useful when someone else can find the hazard from the description and photo alone, when it shows what was done straight away, and when the person who reported it is told what happened.

Last updated . Facts checked by the SiteSurvey team on 27 October 2026 against Management of Health and Safety at Work Regulations 1999, regulation 14, employees' duties, Management of Health and Safety at Work Regulations 1999, regulation 3, risk assessment, Employment Rights Act 1996, section 44, health and safety cases, Workplace (Health, Safety and Welfare) Regulations 1992, regulation 12, floors and traffic routes and OSHA 29 CFR 1977.9, complaints under or related to the Act (eCFR).

How to fill in a hazard report form

If the hazard could hurt someone now, keep people away and tell a manager first. Fill the form in once it is safe.

  1. Say where and when

    Enter the date, capture the GPS position and describe exactly where the hazard is. Choose whether to give your name.

  2. Describe the hazard

    Pick the kind of hazard, say how someone could be hurt and who, and take one photo that shows where it is and one close up.

  3. Record what you did

    Say whether you made it safe, put up a sign or barrier, kept people away or told someone, and how serious you think it is.

  4. Manager responds

    The manager looks at it, records the finding and the risk, checks the risk assessment, and adds actions with an owner and a due date.

  5. Walk the area and give feedback

    Optionally walk the area with the hazard checklist, then tell the reporter what was done and close the report once the actions are checked.

What makes a hazard report useful

Describe the hazard

Extension lead and four-way adaptor on the corridor floor by the office socket, lead looped across the walkway to the laminator table outside the staff room. Staff and children walk this way to the hall. Told C. Doyle at 08:25 and kept children to the other side until it was unplugged.

Fictional example. Record the actual evidence and approved arrangements for your job.

A common recording mistake

Writing "cable in corridor" with no photo and no exact place, so the caretaker has to hunt for it and the report is closed as not found.

What happens next

Deal with it, record the action and its owner, check it on site, and tell the reporter what was done or why nothing was needed.

Try the hazard report form form live

Answer a few questions and watch it adapt. Your answers are not saved, and any photos you add are deleted within the hour.

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This is the real form as your team would use it: questions appear as you answer, scores work themselves out and you can add photos and signatures. No sign-up needed. Or open a completed example to see every answer, photo and score filled in.

Want to see one filled in? See a completed hazard report form report (PDF), made by SiteSurvey from a fictional site visit.

Every question in the hazard report form template

A hazard report form anyone can fill in, in any workplace: date, time and place with GPS, with or without the reporter's name, the kind of hazard, a description and photos, who could be harmed, what was done straight away, how serious it seems on your own low, medium or high scale, and what would fix it. The manager records what they found, the risk and the risk assessment, actions with an owner and due date, and the feedback given to the reporter. An optional hazard identification walk-round checks each area for common workplace hazards, from trip hazards and stairs to fire exits and chemicals. 5 sections and 88 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.

Make it your own: every question is editable

This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.

Details you only enter once

Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.

  • Project: the project name
  • Workplace address: the site address, from the space or the project
  • Organisation: the project's customer

Report details

  • ProjectShort answer

    Filled in from the project in SiteSurvey.

    Fills in from the project name
  • Workplace addressShort answer
    Fills in from the site address, from the space or the project
  • OrganisationShort answer
    Fills in from the project's customer
  • Location (GPS)Short answer
  • Date reported*Date
  • TimeTime
  • Your name on this report*Choose one
    • Give my name
    • Report without my name
  • Your nameShort answer
    Shown when “Your name on this report” is “Give my name”
  • Your roleChoose one
    • Employee
    • Supervisor or manager
    • Contractor or agency worker
    • Safety representative
    • Visitor
    • Other
  • How to give you feedbackShort answer

    Optional. For example your team, extension or email.

    Shown when “Your name on this report” is “Give my name”
  • CheckLeaving your name off does not on its own make this report anonymous: the app or link you used may still show who sent it. Ask how your organisation handles hazard reports if this matters to you.
    Shown when “Your name on this report” is “Report without my name”
  • Where is the hazard?*Short answer

    Building, floor, room or area, as exactly as you can.

  • CountryChoose one

    Sets which short note you see. It does not change the questions.

    • UK (England, Scotland, Wales)
    • US (OSHA)
    • Other country
  • CheckA hazard report records one thing that could cause harm, raised by anyone, and what the manager did about it. If someone was hurt or nearly hurt, fill in an incident report as well.
  • GuidanceUK. Employees must tell their employer about any work situation they reasonably consider a serious and immediate danger, and about shortcomings in the protection arrangements (Management of Health and Safety at Work Regulations 1999, regulation 14(2)). Safety representatives can investigate potential hazards and employee complaints (Safety Representatives and Safety Committees Regulations 1977, regulation 4). Where there is no safety representative or committee, or it is not reasonably practicable to use them, an employee who raises a health and safety concern with the employer by reasonable means has the right not to be subjected to a detriment for it (Employment Rights Act 1996, section 44).
    Shown when “Country” is “UK (England, Scotland, Wales)”
  • GuidanceUS. Section 11(c) of the OSH Act protects employees against discrimination for safety and health complaints, and OSHA's rules say a good-faith complaint to the employer is covered (29 CFR 1977.9(c)). 29 CFR 1904.36 adds that it is unlawful to discriminate against an employee for reporting a work-related injury or illness.
    Shown when “Country” is “US (OSHA)”

The hazard

  • What kind of hazard?*Choose one
    • Slip, trip or fall
    • Work at height
    • Electrical
    • Machinery or equipment
    • Vehicles or traffic routes
    • Manual handling
    • Hazardous substances
    • Fire
    • Noise or vibration
    • Temperature or ventilation
    • Violence or aggression
    • Workload or stress
    • Housekeeping
    • Other
  • OtherShort answer
    Shown when “What kind of hazard?” is “Other”
  • Describe the hazard*Notes

    What it is, exactly where, and how someone could get hurt.

  • PhotosPhotos

    One photo that shows where it is, then one close up. Only if it is safe to take them.

  • Who could be harmed?*Tick all that apply
    • Employees
    • Contractors
    • Visitors or the public
    • Pupils, patients or residents
    • Young workers
    • New or expectant mothers
    • Disabled people
    • Cleaners or out-of-hours staff
    • Other
  • How often are people exposed?Choose one
    • All the time
    • Every day
    • Now and then
    • Rarely
  • Could it hurt someone right now?*Yes or No
  • What did you do straight away?*Tick all that apply
    • Made it safe myself (only where safe to)
    • Put up a sign, cones or a barrier
    • Kept people away
    • Told my supervisor or manager
    • Reported it to facilities or maintenance
    • Nothing yet
  • How did you make it safe?Notes
    Shown when “What did you do straight away?” includes “Made it safe myself (only where safe to)”
  • Who did you tell, and when?Short answer
    Shown when “What did you do straight away?” includes “Told my supervisor or manager”
  • WarningIt could hurt someone now and nothing has been done yet. Keep people away if you safely can and tell a manager straight away. Do not wait for this report to be read.
    Shown when “Could it hurt someone right now?” is Yes and “What did you do straight away?” includes “Nothing yet”
  • How serious do you think it is?*Choose one

    Your organisation's own scale: how bad the harm could be and how likely. It is not a standard rating.

    • Low
    • Medium
    • High
  • What would fix it?Notes

    Optional. You often know the best answer.

Manager's response

  • Received by*Short answer
  • Date receivedDate
  • Has the manager looked at the hazard?Yes or No
  • What did the manager find?*Choose one
    • Hazard confirmed: action needed
    • Hazard confirmed: already removed or controlled
    • Not a hazard: explained to the reporter
    • Could not find it
  • Risk, on your organisation's scaleChoose one
    • Low
    • Medium
    • High
    Shown only when the answers above make it relevant
  • Is it covered by a risk assessment?Choose one
    • Yes, and the controls are adequate
    • Yes, but the controls need changing
    • No: add it to the risk assessment
    • Not known
    Shown only when the answers above make it relevant
  • Risk assessment referenceShort answer
    Shown only when the answers above make it relevant
  • GuidanceUK: employers must assess the risks to employees and others, and review the assessment if there is reason to suspect it is no longer valid (Management of Health and Safety at Work Regulations 1999, regulation 3).
    Shown only when the answers above make it relevant
  • Manager's notesNotes
  • PhotosPhotos

Hazard identification walk-round (optional)

  • Add a hazard identification walk-round of the area?*Yes or No

    Use this when a manager or safety representative walks the area to look for other hazards. The hazard reported on page 2 stays there.

  • Areas walked
    Repeat for each area. Each one asks:
    Shown when “Add a hazard identification walk-round of the area?” is Yes
    • Area*Short answer
    • TypeChoose one
      • Office
      • Corridor or stairs
      • Classroom
      • Hall
      • Kitchen
      • Ward or clinic
      • Store or plant room
      • Workshop
      • Warehouse
      • Outside area
      • Other
    • Floors and walkways free of trip hazards and obstructionsChoose one

      Trailing cables, boxes, loose mats, spills.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Floor surfaces in good repairChoose one

      No holes, lifted edges or uneven areas.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Stairs and steps sound, with handrailsChoose one

      No broken or loose treads or nosings.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Lighting adequate, no failed lightsChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Electrical equipment, leads and sockets undamagedChoose one

      No overloaded adaptors or daisy-chained extension leads.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Storage stable, heavy items lowChoose one

      Nothing stacked unsafely at height.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Fire exits and escape routes clear, fire doors not wedged openChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Fire extinguishers and alarm call points in place and not blockedChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Hazardous substances stored and labelledChoose one

      Cleaning chemicals locked away where others could reach them.

      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Machinery and equipment guards in placeChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Temperature and ventilation reasonableChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Waste and housekeeping under controlChoose one
      • Acceptable
      • Action needed
      • Not checked
      • Not applicable
    • What needs doing, or why not checkedNotes
      Shown only when the answers above make it relevant
    • Hazards found in this areaWorked out by the form
    • Not checkedWorked out by the form
    • PhotosPhotos
    • NotesNotes
  • Areas walkedWorked out by the form
    Shown when “Add a hazard identification walk-round of the area?” is Yes
  • Hazards found on the walk-roundWorked out by the form
    Shown when “Add a hazard identification walk-round of the area?” is Yes
  • Walk-round filmWalk Cam video with voice-to-text

    Optional. Film a guided walk-round on the SiteSurvey app.

    Shown when “Add a hazard identification walk-round of the area?” is Yes

Actions, feedback and sign-off

  • Hazards needing actionWorked out by the form

    The reported hazard if confirmed, plus any found on the walk-round.

  • ResultWorked out by the form
  • Actions
    Repeat for each action. Each one asks:
    • Action*Notes
    • PriorityChoose one
      • Now: keep people away until fixed
      • Within 24 hours
      • Within a week
      • At the next planned work
    • Who will do it*Short answer
    • Due byDate
    • Status*Choose one
      • Open
      • In progress
      • Done, checked
    • Photo when donePhotos
      Shown when “Status” is “Done, checked”
  • Actions still openWorked out by the form
  • Decision*Choose one
    • Closed: hazard removed or controlled and checked
    • Open: actions in progress
    • No action needed: explained to the reporter
    • Passed to someone else to deal with
  • WarningActions are still open, but the report is marked closed. Finish and check the actions, or mark it open.
    Shown only when the answers above make it relevant
  • Date to look at it againDate
  • Passed toShort answer
    Shown when “Decision” is “Passed to someone else to deal with”
  • Has the reporter been told what was done?*Yes or No
  • Date of feedbackDate
    Shown when “Has the reporter been told what was done?” is Yes
  • HowChoose one
    • In person
    • Email or message
    • At a team meeting
    • Notice board or bulletin
    Shown when “Has the reporter been told what was done?” is Yes
  • What they were toldNotes
    Shown when “Has the reporter been told what was done?” is Yes
  • CheckTell the reporter what was done, or why nothing was needed. If the report has no name, share the outcome with the team instead.
    Shown when “Has the reporter been told what was done?” is No
  • SummaryNotes
  • Manager nameShort answer
  • Manager signature*Signature
  • Health and safety adviser or safety representative nameShort answer
  • Health and safety adviser or safety representative signatureSignature

See it filled in

A completed hazard report form report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.

See completed form (PDF) ↗

Hazard report form FAQs

Can a hazard report be anonymous?

The form lets the reporter leave their name off, but that does not on its own make the report anonymous: the app or link used to send it may still show who sent it. If anonymity matters, ask how your organisation handles hazard reports. When there is no name, the form suggests sharing the outcome with the team instead of the reporter.

Do employees have to report hazards?

In Great Britain, employees must tell their employer, or the person responsible for health and safety, about any work situation they reasonably consider a serious and immediate danger, and about shortcomings in the protection arrangements (Management of Health and Safety at Work Regulations 1999, regulation 14(2)). Safety representatives can investigate potential hazards and employee complaints, and employees who are not represented by them must be consulted by the employer on health and safety matters.

Sources: Management of Health and Safety at Work Regulations 1999, regulation 14, employees' duties, Safety Representatives and Safety Committees Regulations 1977, regulation 4, functions of safety representatives and Health and Safety (Consultation with Employees) Regulations 1996, regulation 3, duty to consult.

Is someone protected when they report a hazard?

In Great Britain, an employee who brings a health and safety concern to the employer by reasonable means, where there is no safety representative or committee or it is not reasonably practicable to use them, has the right not to be subjected to a detriment for it (Employment Rights Act 1996, section 44). In the US, OSHA's rules say a good-faith safety complaint to the employer is protected under section 11(c) of the OSH Act (29 CFR 1977.9(c)), and 29 CFR 1904.36 says the same section protects employees who report a work-related injury or illness.

Sources: Employment Rights Act 1996, section 44, health and safety cases, OSHA 29 CFR 1977.9, complaints under or related to the Act (eCFR) and OSHA 29 CFR 1904.36, prohibition against discrimination (eCFR).

What does the hazard identification checklist cover?

Twelve common workplace hazards, checked area by area: trip hazards and obstructions, floor condition, stairs and handrails, lighting, electrical equipment and leads, storage, fire exits, fire equipment, hazardous substances, machinery guards, temperature and ventilation, and housekeeping. In Great Britain, floors and traffic routes must be kept free, so far as reasonably practicable, of obstructions and anything that may cause a slip, trip or fall, and staircases need handrails, with limited exceptions (Workplace Regulations 1992, regulation 12).

Source: Workplace (Health, Safety and Welfare) Regulations 1992, regulation 12, floors and traffic routes.

How is this different from a safety observation report?

A safety observation report records one thing seen on a construction site, good or at risk, including safe acts worth repeating. This form is only for hazards, in any workplace, and puts more weight on the manager's response and on telling the reporter what happened. Both can sit alongside an incident report if someone was hurt.

What happens after a hazard is reported?

The manager looks at it, records whether it is a hazard and how serious it is on your own scale, and checks whether the risk assessment covers it. In Great Britain the assessment must be reviewed if there is reason to suspect it is no longer valid (Management of Health and Safety at Work Regulations 1999, regulation 3). Actions get an owner and a due date, and the reporter is told the outcome. The finished report is a PDF you can share as a link; SiteSurvey does not send reminders for due dates.

Source: Management of Health and Safety at Work Regulations 1999, regulation 3, risk assessment.

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