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Date/Time Occurred *
Full Name *
Location *
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Albany
Auckland Airport
Auckland Uni
Christchurch Central
Dunedin
Glenfield
Hamilton
Head Office - Assembly
Head Office - Breezeway
Head Office - Inwards
Head Office - Main Building
Head Office - Other
Head Office - RA
Head Office - Ryan Place
Head Office - Service
Head Office - Warehouse
Henderson
Hornby
Lady Rudy Drive - Assembly
Lady Rudy Drive - Office
Lady Rudy Drive - Other
Lady Rudy Drive - Warehouse
Manukau Showroom
New Plymouth
Newmarket
Palmerston North
Penrose
Petone
Queen Street
Ryan Place Office
St Lukes
Tauranga
Wellington
Westgate
Other
Specific Area *
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Email Address
Description of the hazard *
Affected Persons Name
Persons Status
Employee
Temp
Visitor
Other
Other
Hazards Involved *
Poor Housekeeping/Storage
Forklift/Reach Truck/Auto Picker
Wear & Tear
Property Damage
Stock Merchadising
Electrical/Lighting
Vehicles: Couriers/Trucks
Weather/Environment
Manual Handling
LPG/Lithium Batteries
Cardboard Cutters
Violence/Aggression
Plastic/Cardboard Compactor
People: Employees, Contractors, Visitors
eScooters
Racking
Ladders
Pallets
Fire Extinguishers
Pallet Jack
Storage Containers
Stock Trolley
Other
Have you taken any action on this hazard?
What action did you take?
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