Get Accident/incident Reporting Form - Cdn Esa Act Gov

Completing the Accident/Incident Reporting Form accurately is essential for documenting incidents in compliance with regulatory requirements. This guide provides a clear, step-by-step approach to assist users throughout the online filling process.

Follow the steps to successfully complete the form:

1. Click ‘Get Form’ button to access the form and open it online.
2. Begin by filling out the 'Person Completing this Form' section. Enter your first name, surname, preferred contact number, position title or level, then provide your signature along with the date.
3. In the 'Person Affected' section, indicate the status of the affected person by circling or detailing whether they are an ACT government employee, a volunteer emergency worker, or a third party. Provide their first name, surname, relevant agency, brigade/unit, preferred contact number, gender, and email address.
4. Document when the incident occurred by entering the date and time in the specified fields.
5. Specify where the incident or accident occurred. Include a map reference or street address, along with an exact location (e.g., shed, truck, fireground).
6. Summarize the incident or accident in detail, highlighting the outcome and impact at the time of reporting. Indicate if this was a near miss or detail the nature of any injury or illness.
7. Answer the questions regarding violence, bullying, harassment, or discrimination involved in the incident. Indicate if appropriate personal protective equipment was required or worn and provide details if necessary.
8. In the background section, describe the task being performed during the incident, along with lead-up actions. Confirm if the incident was related to the task and your experience level.
9. Provide information about any corrective actions taken immediately after the incident and whether any long-term preventative actions are required.
10. List witness details, including first name, surname, position title, and preferred contact number.
11. Record details of the supervisor present at the time of the incident, including their name and contact number.
12. Indicate if the incident is a WorkSafe notifiable event, sign the form, and enter the date.
13. Upon completing all sections, you can save changes, download, print, or share the form as needed.

Complete your Accident/Incident Reporting Form online today to ensure accurate documentation of workplace incidents!