Incident and Hazard Report Form
v2.1
Purpose. Used by any worker to report an injury, near miss, hazard, property damage or animal welfare event so that it can be recorded, investigated and controlled.
1.When to use this form
Complete this form for every injury regardless of severity, every near miss, every hazard you notice and every event involving damage to plant or product. Complete it before the end of the shift in which the event occurred. Your leading hand or a first aider will help you complete it if you are injured.
2.What happens next
The completed form is entered into the incident register by the People and Safety team. Notifiable incidents are escalated to the People and Safety Manager immediately. The department manager reviews the report within one working day and assigns corrective actions, which are tracked to closure.
3.Describing the event
Describe what happened in plain words, in the order it happened, including what task was being done, what equipment was in use and what conditions were present. Do not write opinions about fault or blame. Include the names of witnesses.
4.Preserving the scene
For a serious injury or a notifiable incident, do not disturb the scene until the People and Safety Manager has released it, other than to help the injured person or make the area safe. Photograph the scene if it is safe to do so.
5.Privacy
Information on this form is used only for safety management, workers compensation and regulatory reporting. Medical information will be stored separately and accessed only by the People and Safety team.