Incident and Hazard Report Form

Purpose. Used by any worker to report an injury, illness, near miss, hazard, spill, vessel or vehicle incident so that it is recorded, investigated and closed.

1.When to use this form

Complete this form for any injury or illness at work, near miss, hazard, chemical or fuel spill, equipment failure that put someone at risk, vessel incident, forklift or truck incident, or property damage. The form must be completed on the day by the person involved or the person who saw it and given to the supervisor or the master.

2.First actions

Make the area safe, give or obtain first aid and tell the supervisor or master before completing the form. At sea the master must decide whether to return to port or call for assistance. Do not disturb the scene of a serious incident until the supervisor has seen it.

3.Completing the form

Describe what happened in order with times, the vessel, site, equipment, chemicals or gear involved, the weather and sea state if at sea, the people involved and any witnesses. Record first aid and whether medical treatment was sought.

4.What happens next

The supervisor enters the report in the WHS Incident and Hazard Register, investigates and records corrective actions. The General Manager decides whether the incident is notifiable to the work health and safety regulator or the maritime regulator.

5.Privacy

Medical information is used only to manage the incident and is kept in the confidential safety file.

6.Complete the form