Electrical Hazard Reporting Form

In the event of that you notice an electrical hazard, please complete the below form.

Please be a precise as you can be and give as many details as possible.

Date of Report?

YYYY

Time

Hour

Minute

Second

Name of person reporting electrical hazard?

Witnesses:

Details of fault

Location Equipment Description Fauly Description

Has anyone been injured?

If yes, please complete a Hazard and Reporting Form.

Yes

Is this repair urgent?

Yes