Incident and Hazard Report Form
v2.1
Purpose. Used by any worker to report an injury, near miss, hazard, property damage or environmental incident on the day it occurs.
1.When to use this form
Complete this form for every injury, illness, near miss, hazard, property damage, spill, dust escape or environmental incident, however minor. The form must be completed before the end of the shift and handed to the supervisor, who must enter it in the incident and hazard register.
2.Immediate actions
Make the area safe first. Provide first aid, isolate plant and stop work in the area if there is an ongoing risk. Do not disturb the scene of a serious incident until the Safety and Environment Manager has released it. Report notifiable incidents to the Safety and Environment Manager by the fastest means available.
3.Describing what happened
Describe the sequence of events in plain words, what plant and materials were involved, who was present and what conditions applied such as lighting, weather or time in shift. Record facts, not opinions about blame. Attach photographs where they help.
4.Classification
The supervisor will classify the report by type and by actual and potential severity using the risk matrix in the risk assessment procedure. High potential events must be escalated to the department manager and the Safety and Environment Manager the same day.
5.Follow up
The supervisor will record the immediate corrective actions and the person responsible. The Safety and Environment Manager will decide whether a formal investigation is required and will track all actions to closure in the register.