Get Work Health And Safety Incident Report Form

Filling out the Work Health And Safety Incident Report Form online is a crucial step in documenting workplace incidents. This guide will walk you through the process, ensuring you provide all necessary information accurately and effectively.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify the person completing the form. Fill in your first name, surname, email address, position/job title, and contact phone number in the designated fields.
3. Select the type of incident you are reporting by circling one of the options: Injury, Illness, Hazard, or Near Miss. If applicable, indicate any property or environmental damage.
4. Provide details about the injured or ill person by entering their family name, given name(s), staff position or student number, date of birth, gender, home address, and phone numbers.
5. Describe the incident. Include a detailed account of what happened, specifying the date and time of the incident, where it occurred, and any witnesses present.
6. In the injury/illness details section, indicate the type of injury, treatment received, and a description of the injury or illness. Document the task being undertaken at the time of the incident.
7. If applicable, provide witness details including their name and phone number.
8. Supervisor nominated to receive the report must complete the corrective actions section by identifying immediate causes and possible contributing factors, along with a corrective action plan.
9. Complete the risk assessment section by evaluating the consequences and likelihood of the incident occurring again, and assign a risk score.
10. Fill in the supervisor/manager details. Include their name, position, email, and phone number. Ensure to forward the completed form to the CEO for filing.
11. Once all sections are filled out, save your changes, download the form, print it, or share it as needed.

Complete your Work Health And Safety Incident Report Form online today to ensure all incidents are properly documented and addressed.