Incident and Hazard Report Form
v2.3
Purpose. Workers use this form to report injuries, near misses, hazards, animal escapes and property damage on the day they occur.
1.When to use this form
Complete this form for any injury to a person, any bite or scratch that breaks the skin, any near miss, any hazard you cannot fix on the spot, any animal escape and any damage to vehicles, buildings or equipment. Complete it before the end of your shift and give it to your supervisor. Your supervisor will enter it in the WHS Incident and Hazard Register.
2.Immediate actions first
Before completing the form, make the area safe, secure any animal involved, give or get first aid and tell your supervisor. If a person needs medical attention, that comes before paperwork. Where an animal has bitten a person, flag the animal in the Animal Register so that other workers are warned.
3.Describing what happened
Describe the sequence of events in plain words: what you were doing, what happened, who was involved and what the outcome was. Record the facts you saw rather than opinions about cause. Name any witnesses. Attach photographs where they help.
- What task was being done
- What equipment and controls were in use
- What went wrong
- What was done immediately afterwards
4.Supervisor section
The supervisor must record the initial risk rating, any immediate corrective action taken and whether the incident requires investigation or regulator notification. The Operations Manager will assign an investigator for any incident rated medium or above.
5.Privacy
Information on this form is used to manage safety and meet legal obligations. It is stored in the WHS Incident and Hazard Register and is available only to the people managing the incident.