Incident and Hazard Report Form
v2.1
Purpose. Workers complete this form to report any injury, near miss, hazard, chemical spill or property damage so it can be 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 property or involved a chemical spill or exposure. Complete it before the end of the shift on which the event occurred. If you are unsure whether an event needs reporting, report it.
2.How to complete it
Describe what happened in plain words, in the order it happened, and name the machine, chemical or material involved. Record the names of witnesses. Do not write opinions about fault. Hand the completed form to your department lead, who will give you the register number.
3.What happens next
Your department lead enters the event in the WHS Incident and Hazard Register. The Quality and WHS Coordinator classifies it, decides whether an investigation is needed and tells you the outcome. Corrective actions are tracked until they are verified.
4.Privacy
Personal information on this form is used only to manage the event, meet legal reporting duties and improve safety. It is kept in the WHS file and is not shared beyond the people who need it to act.
5.Related documents
Read this form with the Occupational Health and Safety Policy, in particular its hazard and incident reporting section. Chemical events must also be checked against the Chemical Safety Policy and the safety data sheet.