LBT Incident, Hazard or Improvement Report
Use this form to report incidents that have occurred and for reporting hazards and improvements.
Date:
When incident occurred or when a hazard or improvement was identified
MM
/
DD
/
YYYY
Location:
Where did the incident occur? Where is the hazard? Where can improvements be made?
Your answer
Incident, Hazard or Improvement:
What happened? What hazard have you identified? What improvement can you suggest?
Your answer
Immediate Response:
What immediate steps were taken to respond to the incident or reduce the hazard? Did you make any immediate improvements?
Your answer
Future Response:
What steps do you suggest to reduce the chance of a similar incident occurring again or for further reducing a hazard? What can LBT do to make further improvements?
Your answer
Who was involved or can provide additional useful information?:
Your answer
Report prepared by:
Your answer
Reviewed by:
Reviewed by: LBT Committee or someone nominated by the Committee
Your answer
Date of review:
MM
/
DD
/
YYYY
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