Opera Australia Hazard Report Form - Confidential
This form is used to report workplace hazards. The form is for staff, contractors, volunteers and visitors.
A separate form is completed for each hazard.
If you are aware of a hazard in your workplace, you should report it promptly to your supervisor, employer or health and safety representative. Once a hazard has been identified, your employer and/or supervisor has a duty to assess the problem and eliminate any hazard that could injure workers.
Physical hazards are the most common hazards and are present in most workplaces at some time. Examples include: frayed electrical cords, unguarded machinery, exposed moving parts, constant loud noise, vibrations, working from ladders, scaffolding or heights, spills, tripping hazards.
First Name (of person reporting Hazard)
Last Name (Surname)
Administration and Shared Services
Workshop and Scenic Art
Wigs and Wardrobe
Touring and Outreach
Full Name of your Reporting Manager
Contact Number or Email Address
When did you notice this hazard?
Location of Hazard (Building, Level etc)
Description of Location
Where is this hazard exactly? (e.g. on stage, wardrobe area, workshop etc, and on the table/wall/electrical power board, machinery etc)
Description of Hazard
Provide details on what the hazard is, how you think it may have occurred, how it could be a hazard to others, and what parts of the body it may affect.
Likelihood of Injury from this Hazard
1. Almost Certain - RECTIFY IMMEDIATELY
2. Likely - Will probably occur if left unattended
3. Possible - Might occur at some time, should be reviewed at earliest availability
4. Unlikely - Could occur some time, but not likely
5. Rare - would only occur in exceptional circumstances, or if hazard is further tampered with.
Consequences - How severe would an injury be?
4. Minor (only First Aid required)
1. Catastrophic (death, toxic release of chemicals, destruction of property)
2. Major (extensive injuries, loss of time/productivity)
3. Moderate (some medical attention/treatment with outside help)
Describe Any Immediate Action Taken?
Was any action taken to temporarily minimize the hazard? E.g. was some electrical tape used, or was some material used to cover the hazard, or was a sign placed in the hazard region to notify others?
Has an injury result from this hazard?
Suggested Corrective Action
Please upload any additional documents such as photos of the hazard.
By ticking this box, I confirm that the information provided above is accurate to my knowledge, and I consent to the use of this information for the purposes of Workplace Health & Safety of Opera Australia.
This form will be submitted to Human Resources for further action as necessary.
For further information and/or support, please contact either Bill Koukoumas (firstname.lastname@example.org) or Nitya Ramaswamy (email@example.com) in Human Resources.
Send me a copy of my responses
Your submission is being processed. Please do not close this browser window until complete.