Incident and Hazard Report Form
v2.1
Purpose. Workers use this form to report any injury, illness, near miss, hazard, property damage or aggressive behaviour so that it is recorded and investigated.
1.When to use this form
Complete this form for every incident or hazard, no matter how minor it seems, before the end of your shift. If someone is hurt, get help first and complete the form afterwards. One form is needed for each person injured.
2.Who completes it
The worker involved completes the form where they are able to. Otherwise the first worker on the scene or the duty manager completes it. Guests who wish to report an incident are helped to do so by the duty manager.
3.What to include
Describe what happened in plain words and in order, state where it happened, who was present and what was done immediately afterwards. Include the equipment, chemicals or food involved and any photographs taken.
4.After submission
Give the form to the duty manager, who enters it in the WHS register and starts the investigation. You will be told the outcome and any changes made.
5.Privacy
Personal information on this form is used only to manage the incident, meet legal reporting obligations and improve safety. Medical details are stored securely and shared only with those who need them.