Incident and Hazard Report Form
v2.0
Purpose. This form is completed for every injury, exposure, near miss, hazard, vehicle incident, property damage or identification discrepancy at any Everlasting site or vehicle.
1.When to use this form
Complete this form on the day the event occurs or the hazard is noticed. Use it for injuries, sharps or splash exposures, manual handling strains, vehicle incidents, excavation or plant events, chemical spills, and any discrepancy in identification, documentation or custody of a deceased person. A discrepancy that is caught and corrected is still reported.
2.Who completes it
The person involved or the person who noticed the hazard completes sections one to three. Their supervisor completes the immediate action section and enters the report in the WHS incident register within two hours. The Compliance and Records Manager assigns the investigation and closes the record.
3.Notifiable incidents
A death, serious injury or illness, or a dangerous incident such as an excavation collapse, uncontrolled chemical release or plant failure must be reported to the regulator immediately by phone by the General Manager or delegate, and the site preserved until the regulator advises otherwise. The supervisor will call the General Manager before doing anything other than making the area safe and providing first aid.
4.Privacy
Names of injured workers and details of deceased persons on this form are confidential. The form is stored with the WHS incident register and released only to those investigating the event, the worker involved and the regulator where required.
5.Follow-up
Every report receives a risk rating, an investigation proportionate to the risk and corrective actions with an owner and due date. The supervisor will tell the reporter what action was taken. Trends are reviewed at the quarterly safety committee.