Incident and Hazard Report Form
v2.0
Purpose. Used by any worker to report an injury, near miss, hazard, chemical exposure or property damage so it can be recorded in the safety register, investigated and controlled.
1.When to use this form
Complete this form for every injury regardless of severity, every near miss, every hazard you notice, every spill or exposure and every event involving damage to plant, product or vehicles. Complete it before the end of the shift. Your supervisor or a first aider will help if you are injured.
2.What happens next
The Safety and Training Coordinator enters the form in the safety register. Notifiable incidents are escalated immediately. Your supervisor reviews the report within one working day and assigns corrective actions that are tracked to closure and reported at the safety committee.
3.Describing the event
Describe what happened in the order it happened, including the task, the equipment, the materials and the conditions. Stick to facts and leave out opinions about fault. Name any witnesses.
4.Preserving the scene
For a serious injury or a notifiable incident, do not disturb the scene until the Safety and Training Coordinator releases it, other than to help the injured person or make the area safe. Take photographs if it is safe.
5.Privacy
Information on this form is used only for safety management, workers compensation and regulatory reporting. Medical information is stored separately with restricted access.