Incident and Hazard Report Form
v2.2
Purpose. Workers use this form to report injuries, near misses, hazards, chemical exposures and property damage at any site, including customer sites, so the event is entered in the register and investigated.
1.When to use this form
Use this form for any event that hurt someone, had the potential to hurt someone, damaged equipment or involved a chemical spill, fume exposure or burn. Complete it before the end of the shift. Site crews must complete it before leaving the customer site and must also report the event to the customer under the customer's rules.
2.How to complete it
Describe what happened in plain words and in sequence. Name the machine, tool, chemical or material involved, whether a guard or isolation was in place, and any witnesses. Do not write opinions about fault. Hand the form to your supervisor, who will enter it in the WHS Incident and Hazard Register and give you the register number.
3.What happens next
The Technical, Quality and WHS Manager classifies the event and assigns a risk rating from the matrix in the WHS Management Plan. Events involving machine access, isolation or a burn from hot material are always investigated. You will be told the outcome and any actions.
4.Privacy
Personal information on this form is used only to manage the event, meet legal duties and improve safety, and is kept in the WHS file.
5.Related documents
Read this form with the Work Health and Safety Policy and the Machine Safety and Isolation Policy.