Template

Bonus Program Hazard Report and Payout

by Heike Martin, from the Community

This mining hazard reporting template supports a quarterly bonus program by capturing hazards identified across departments and shifts. Record location, shift details, equipment involvement, and classify issues by critical risk areas such as conveyor belts, vehicle interactions, and energy isolation, as well as by PTW programs and energy types. Document immediate actions and added controls from elimination through PPE, and note if work was stopped. Track cyanide-related hazards, define long-term corrective actions with owners and measurable checks, and propose new critical risk topics for review. Built for maintenance, mining, mill, and support teams to improve safety performance and reward proactive reporting.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions .

Template
Bonus Program CRM Impact Form
Use this mining CRM Impact form to record critical risk incidents and injuries across departments such as maintenance, operations, processing, geology, and safety. Log site details, shift and rotation, equipment involved, permit to work program, energy isolation, and the specific critical risk category. Capture full incident descriptions, photos, immediate actions, notifications, and added controls following the hierarchy of controls. Classify event type and loss, including near miss, first aid, medical injury, or fatal, and select incident mechanisms like struck by, falls, caught in or between, contact with energy, equipment failure, or abnormal operation. Track corrective and potential long term actions to strengthen controls and improve safety performance.
by Heike Martin, from the Community
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Template
Hazard Reporting Form with Risk Assessment
Capture and report hazards on site with a structured form that guides teams from identification to control. Record project and site details, describe the hazard and context, add photos, and assess risk by consequence, likelihood, and overall rating. Document immediate controls, take after-action photos, and note long term recommendations. Includes fields for worker sign off, supervisor comments, and whether a formal risk assessment is required. Ideal for construction and general workplace safety.
by Matt Crozier, from the Community
Downloads: 10+
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Template
Podium Industries Hazard Report Form
Use this Hazard Report Form to capture and manage workplace hazards from identification through control. Record site and personnel details, describe the hazard and context, select hazard types such as manual tasks, machinery and equipment, hazardous chemicals, electricity, extreme temperature, noise, radiation, biological, or psychosocial. Assess risk by noting consequence and likelihood to generate a risk rating. Document immediate controls, add photos before and after, and outline long-term recommendations. Capture sign-offs from the person raising the hazard and collect supervisor or HSR comments, including follow-up actions and whether a formal risk assessment is recommended.
by Aaron Hancock, from the Community
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Template
Hazard ID and Rectification Checklist
This practical checklist helps personnel identify hazards on site, capture before and after evidence, record what was done to remove the hazard, and document follow-up actions. Sections include title page, name, date and time, crew, hazard identified, hazard before and after, corrective actions taken, recurrence risk, and prevention steps required. It supports clear assignment of actions and sign-off to ensure issues are addressed and lessons are captured. Built for mining and field operations, it can be adapted to any workplace aiming to improve hazard reporting and rectification.
by James Feakes, from the Community
Downloads: 10+
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Bonus Program Hazard Report and Payout

About author

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Bonus Program CRM Impact Form

Hazard Reporting Form with Risk Assessment

Podium Industries Hazard Report Form

Hazard ID and Rectification Checklist

You might also like

Bonus Program CRM Impact Form

Hazard Reporting Form with Risk Assessment

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