The Hazard Report Form serves as a crucial tool in maintaining workplace safety and regulatory compliance in Belgium. It is designed to be used whenever an employee identifies a potential safety hazard or risk in the workplace, enabling prompt reporting and appropriate response. The form aligns with the Belgian Act of 4 August 1996 on Well-being of Workers and subsequent Royal Decrees, while also adhering to EU safety directives and GDPR requirements. It captures essential information including hazard details, location, risk assessment, and immediate actions taken, forming part of the organization's broader safety management system. This document is instrumental in demonstrating due diligence in hazard identification and risk management, while providing a standardized approach to safety reporting across all organizational levels.
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1. Report Identification: Unique reference number, date and time of report submission
2. Reporter Details: Name, position, department, and contact information of the person reporting the hazard (with GDPR compliance notice)
3. Hazard Location: Specific location details including building, floor, room/area where the hazard was identified
4. Hazard Classification: Type of hazard (chemical, physical, biological, ergonomic, etc.) with checkboxes for easy categorization
5. Hazard Description: Detailed description of the hazard, including current status and potential risks
6. Immediate Actions Taken: Description of any immediate actions taken to minimize risk
7. Risk Assessment: Initial assessment of risk level using standard risk matrix (likelihood vs. severity)
8. Witnesses: Names and contact details of any witnesses (if applicable)
9. Signature and Declaration: Reporter's signature and declaration of truth of information provided
1. Photos/Visual Evidence: Section for attaching or referencing photos or other visual documentation of the hazard
2. Environmental Conditions: Section for recording relevant environmental conditions when applicable (weather, temperature, lighting, etc.)
3. Equipment Details: For hazards involving equipment: make, model, serial number, last maintenance date
4. Previous Incidents: Section for referencing any related previous incidents or hazard reports
5. Third Party Involvement: Details of any contractors, visitors, or third parties involved or affected
6. Cost Implication: Estimated costs associated with the hazard or its remediation
1. Risk Assessment Matrix: Standard risk assessment matrix used for evaluating hazard severity and likelihood
2. Hazard Classification Guide: Reference guide for different types of hazards and their classifications
3. Emergency Contact List: List of relevant emergency contacts and response procedures
4. Follow-up Action Form: Template for documenting corrective actions and their implementation
5. Internal Reporting Flowchart: Diagram showing the internal process for hazard report handling and escalation
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