Minnesota Hazard and Incident Report Form

State:
Multi-State
Control #:
US-435EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used to report all work-related hazards and incidents.

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FAQ

Write an Effective Incident Report in 5 StepsRespond in a Timely Manner.Gather All of the Details and Facts.Piece Together the Sequence of Events.Analyze Your Findings of the Incident.Formulate a Preventative Action Plan.Bottom Line.

For most types of incident, including: accidents resulting in the death of any person. accidents resulting in specified injuries to workers. non-fatal accidents requiring hospital treatment to non-workers.

You must call the OHS Contact Centre (1-866-415-8690) as soon as possible if:a worker has died at work or from an illness connected to the work site.a worker has been or will be admitted to a hospital as a result of a workplace injury, illness or incident.a person has been injured or becomes ill from:

Incident reporting is the process of documenting all worksite injuries, near misses, and accidents. An incident report should be completed at the time an incident occurs no matter how minor an injury is.

Contact Details. You will first need the injured party's details; you need to collect as much as possible just if you may need it. Then you will need the casualties first and last name, telephone number, email address, home address, gender and date of birth.

Under the model WHS (workplace health and safety) act, incidents must be reported immediately after becoming aware of it if they are of a serious nature and therefore notifiable. You may then be asked to provide a written incident report within 48 hours of the request.

Your six-step guideThe person. First and foremost, the person/people reporting accidents must be competent to do so.Log the accident. Next, you need to log the accident in your accident book if you don't have one, you need one.Formal investigation.Is it reportable?Fill in your forms.Review your risk assessments.

Employers are legally required to report certain workplace incidents, near-misses and work-related health issues to the Health and Safety Executive via the RIDDOR and if a report is not sent, employers would face a receiving hefty fine.

Only 'responsible persons' including employers, the self-employed and people in control of work premises should submit reports under RIDDOR. If you are an employee (or representative) or a member of the public wishing to report an incident about which you have concerns, please refer to our advice.

Incident reports should be completed immediately after a near miss, unexpected, awareness, or adverse events have occurred. This ensures that the involved individuals or witnesses can recall the details of the occurrence with clarity to fill the report form accurately.

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Minnesota Hazard and Incident Report Form