Hazardous Locations Report Form

Required fields are marked with ' *  '

*
Date of reporting*
Hazardous Locations Register consulted?*
*

Reporting persons details

*
*
*
*
*
What could cause harm?
*
Is anything currently in place to manage the hazard?
*
What else could be done to reduce the hazard?

Attach a photo of the hazard here.

Rail Safety Coach Details

If you are a Rail Safety Coach, you can fill out this section of the form. If you are not a Rail Safety Coach, please leave this section blank.

Date