Get Accident/serious Harm Notification Form - Massey Ac

This guide provides clear instructions on how to complete the Accident/Serious Harm Notification Form - Massey Ac online. Whether you are a person reporting an incident or a person involved, this guide will assist you in providing accurate and thorough information.

Follow the steps to complete the form easily and effectively.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Begin by filling out section 1 with the particulars of the employer, self-employed person, or principal, including their business name, postal address, and telephone number.
3. In section 2, indicate who is reporting the incident by selecting the appropriate option: employer, principal, or self-employed person.
4. Fill in section 3 with the precise location of the place of work where the accident or serious harm occurred, including relevant details such as shop or building numbers.
5. Complete section 4 with the personal data of the injured person, including their name, residential address, date of birth, and sex.
6. In section 5, specify the occupation or job title of the injured person if they are an employee or self-employed.
7. Select the correct option in section 6 regarding the status of the injured person (e.g., employee, contractor, self).
8. Provide details in section 11 about the agency causing the accident or serious harm from the listed options.
9. Indicate the body part affected in section 12 by selecting from the specified options.
10. In section 13, describe the nature of the injury or disease by checking applicable items.
11. Detail in section 14 where and how the accident or serious harm happened.
12. Complete section 9 by providing the time and date of the incident along with any relevant shift information.
13. In section 10, outline the mechanism of the accident or serious harm.
14. If you are reporting as an employer, complete section 15 by indicating if an investigation was carried out and whether a significant hazard was involved.
15. Finally, review all entered information for accuracy. Use the available options to save changes, download, print, or share the completed form.

Take action now and ensure your document is filled out accurately and submitted online.