Get Notifiable Incident Report Form - Safework Sa - Sa.gov.au

Filling out the Notifiable Incident Report Form is essential for reporting serious injuries, illnesses, or dangerous incidents under the Work Health and Safety Act 2012. This guide provides clear, step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Notifiable Incident Report Form and open it in your preferred editor.
2. Begin by providing the date and time of the incident in the designated fields. Ensure that this information is accurate as it is crucial for record-keeping.
3. Next, specify the exact location of the incident, including the site address, type, suburb, state, and post code to provide clear context for the report.
4. Describe the work that was being performed at the time of the incident and provide a detailed account of what happened. This section should include any machinery or equipment involved.
5. Identify the injured person by filling in their name, occupation, address, sex, work experience, date of birth, phone number, and any known injuries. If applicable, include additional contact details.
6. Indicate the condition of the injured person if known, and specify whether they received immediate treatment, where it was administered, and if they were admitted as an inpatient.
7. Provide information about the Person Conducting a Business or Undertaking (PCBU), including their business name, ABN, contact details, and role related to the incident.
8. Complete the notifier’s details by stating your position and involvement with the site, alongside your contact information to verify your report.
9. In the declaration section, ensure to note the date the form was completed and provide a digital signature confirming that the form has been submitted electronically.
10. Once all required fields are correctly filled out, you can choose to save changes, download a copy for your records, print the filled form, or share it as required with SafeWork SA.

Ensure compliance and safety by completing your documents online today.