Get Hazard Report Form

Filling out the Hazard Report Form online is a crucial process for ensuring workplace safety and accountability. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Hazard Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of report you are filing: circle ‘Incident,’ ‘Accident,’ or ‘Hazard.’ This helps categorize your report correctly.
3. In the ‘Person Involved’ section, fill in the last name, first name, and middle initial of the individual affected. Mark the gender as either male or female.
4. Provide the local home address, city, and zip code of the person involved, along with their birth date and phone number.
5. Document the job title, employee social security number, date of hire at Tupelo Airport, and years of experience in the present position.
6. Record the time the employee began work, the time of the accident, incident, or hazard, and the date of occurrence.
7. Specify where the incident occurred by filling in the building, apron, or any other relevant location.
8. Detail the activities of the employee just before the incident. Be specific about the actions and the tools, equipment, or materials involved.
9. Explain what happened during the incident, providing a clear narrative of the events leading up to it.
10. List the names and addresses of witnesses present during the incident to support your report.
11. If there were injuries, specify the nature of the injury or illness and how it affected the body. Use precise terminology to describe the injury.
12. Indicate which body parts were involved and circle whether they are left, right, upper, lower, top, or bottom. Describe the type of injury or illness.
13. Answer the medical treatment questions, selecting ‘Yes’ or ‘No’ for each item and providing details as necessary.
14. Provide the name of the person who treated the injury and where the treatment occurred.
15. Document any object or substance that directly harmed the employee, specifying if it does not apply.
16. If applicable, record the date of death and ensure to contact the Airport Manager immediately.
17. Describe any corrective actions taken or planned in response to the incident.
18. The form must be signed by the supervisor, and the date should be included prior to submission.
19. Use the space provided for any additional information relevant to the incident.
20. Once completed, review the form for accuracy, then save, download, print, or share it as required.

Complete the Hazard Report Form online to ensure a safe and accountable workplace.