Hazard Report Any forseeable hazard that has the potential of causing an injury requires you to fill in this form. Name of Person completing this report. * First Name Last Name Please enter the site address where the hazard has been identified. 53 Coppin St, Richmond 33 West St, Daylesford 2 Sadie Ave, Thornhill Park 190 Nott St, Port Melbourne 14 Woodruff St, Port Melbourne On a scale of 1 to 10, 1 being minor and 10 being major, please advise the severity of the hazard. * 1 2 3 4 5 6 7 8 9 10 Date that the hazard was identified. * MM DD YYYY Time that the hazard was identified. * Hour Minute Second AM PM What is the nature of the Hazard identified? * Where exactly on site is the hazard located? * Has anyone been injured to your knowledge? * Yes No Has this hazard been reported to a Cubo Projects staff member? * Yes No Thanks for completing the Cubo Projects Hazard Report form. Back to OHSE