CCHO OCCURRENCE & HAZARD REPORT (OHR)

Date of Occurance

Originator (not required)

Classification

Occurrence Report

Hazard Identification Report

Type of Hazards; Check all that apply

Other Type of Hazard not listed if any

Exact Location

Description of the hazard of occurrence and your assessment of potential consequences

Cause of hazard or occurrence, if known.

Frequency of occurrence

First

Second

Third

More

Recommended risk controls or actions