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Injury and Lost Time Incident Report Sample Type of incident (injury, near miss, property damage, or theft) Location (Address) Date/time of incident. Name. Name of supervisor. Description of the incident, including specific job site location, the sequence of events, and the results of the event.
How to Create an NDIS Incident Report Template Who is filling in the report. Who the NDIS participant is. A description of what happened. The impact on the NDIS participant. The time, date and place of the incident. Who was involved in the incident. Contact details for any witnesses.
To help you decide whether or not an incident is reportable, here are some example questions. Road-traffic accidents/accidents caused by vehicles on a road. Q. ... Violence at work. Q. ... Injuries in schools. Q. ... Gas incidents. Q. ... People not at work. Q. ... Suicide and self-harm. Q. ... Mental health issues. Q. ... Occupational diseases.
The death of an NDIS participant. serious injury of an NDIS participant. abuse or neglect of an NDIS participant. unlawful sexual or physical contact with, or assault of, an NDIS participant.
Reportable incidents the death of a person with disability. serious injury of a person with disability. abuse or neglect of a person with disability. unlawful sexual or physical contact with, or assault of, a person with disability.