Follow the steps to complete the form online with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Identify your status by selecting one of the options: Worker (including contractor), Student, or Visitor. This will help categorize your report appropriately.
3. Provide the outcome of the incident by choosing among Incident Only (Near Miss), Accident (Injury), Notifiable Injury, or Other.
4. In the 'Details of person directly involved' section, fill out all required fields, including name, phone number, address, sex, date of birth, email address, position, work arrangement, and supervisor.
5. Fill in the 'Details of witness/es' section with the required information for each witness, including their name and contact numbers.
6. Complete the 'Details of incident' section by entering the date, time, campus location, and specific location of the incident. Describe exactly what happened.
7. In the 'Details of injury' section, provide the nature and cause of the injury, the location on the body affected, and the agency involved.
8. Indicate whether first aid was administered in the 'Treatment administered' section. If yes, provide details of the first aider and treatment.
9. Sign and date the form in the 'Individuals signature' section. Ensure all information is accurately presented.
10. Sections 7-12 must be filled out by the employer. Ensure the details concerning work cessation, incident investigation, risk assessment, and actions to prevent recurrence are adequately addressed.
11. Review your completed form for accuracy and completeness. Once satisfied, you can choose to save changes, download, print, or share the form as necessary.

Complete your document online today to ensure proper reporting and record-keeping.