Hazard and Incident Report Form
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
Specific Details and Description. Facts Only. Objective Tone. Organisation. Witness Statements. Confidential Concerns. Accuracy. Good Grammar.
The time and date the incident occurred. Where the incident occurred. A concise but complete description of the incident. A description of the damages that resulted. The names and contact information of all involved parties and witnesses. Pictures of the area and any property damage.
Date, time, and specific location of incident. Names, job titles, and department of employees involved and immediate supervisor(s) Names and accounts of witnesses. Events leading up to incident. Exactly what employee was doing at the moment of the accident.
Type of incident (injury, near miss, property damage, or theft) Address. Date of incident. Time of incident. Name of affected individual. A narrative description of the incident, including the sequence of events and results of the incident.
The Basics. Identify the specific location, time and date of the incident. The Affected. Collect details of those involved and/or affected by the incident. The Witnesses. The Context. The Actions. The Environment. The Injuries. The Treatment.
Brief description of hazard/incident: (Describe the task, equipment, tools and people involved. Use sketches, if necessary. Include any action taken to ensure the safety of those who may be affected.) Where is the hazard located in the workplace?
An automated form number. The location of the hazard. The date the hazard was identified. The company involved in identifying or interacting with the hazard.
To notify SafeWork NSW of an incident, call 13 10 50. Brief description of hazard/incident: (Describe the task, equipment, tools and people involved. Use sketches, if necessary. Include any action taken to ensure the safety of those who may be affected.)
The definition of an incident is something that happens, possibly as a result of something else. An example of incident is seeing a butterfly while taking a walk. An example of incident is someone going to jail after being arrested for shoplifting. An event or occurrence.
