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Rson Given names Position Position Contact telephone no Description of hazard Contact telephone no Assess the risk High (as per table on back) (Circle which applicable) Medium Low Proposed actions to control the risk utilising the Hierarchy of Control (as per back) Location of hazard What immediate action/s have you taken to rectify this hazard? What further action/s do you believe can rectify this hazard? Person responsible for action/s Planned completion date for action/s: Name of pe.

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