Incident and Hazard Report Form
v2.2
Purpose. The form every worker completes to report an injury, near miss, property damage or hazard at any Craftline site or customer site.
1.When to use this form
Use this form for any injury, illness, near miss, damage to plant, product or property, or a hazard you have noticed. Complete it before the end of your shift and hand it to your supervisor. If you are unable to write, ask a colleague or supervisor to complete it with you.
2.Describe what happened
Write what you saw and did in the order it happened, using plain words. Say which machine, tool, product, substance or vehicle was involved and what the person was doing at the time. Do not guess at causes; the investigation will look at that.
3.Witnesses and first aid
Name any witnesses and record any first aid given, who gave it and whether the person went to a doctor or hospital. If the person continued working, say so.
4.Immediate action
Record what was done straight away to make the area safe, for example tagging out a machine, cleaning up glass or moving stock. Say whether the hazard is still present.
5.What happens next
Your supervisor enters this report in the WHS incident and hazard register and the Quality and Safety Manager decides whether an investigation is needed. You will be told the outcome and any changes that result.