Incident and Hazard Report Form
v2.1
Purpose. Use this form to report any injury, near miss, property damage, chemical spill or hazard so that it can be recorded and investigated.
1.When to use this form
Complete this form for every injury, illness, near miss, property damage event, chemical spill or hazard observed at any PrintWorks site or during an installation. Report to your supervisor first, then complete this form on the same shift. The supervisor will enter the report in the Incident and Hazard Register.
2.Who completes it
The person involved or the person who observed the event completes sections one to three. The supervisor completes the immediate actions section. The Operations and WHS Coordinator completes the investigation and corrective action sections.
3.Describing the event
Describe what happened in plain language, in the order it happened, including the machine, product, chemical or task involved. Do not guess at causes or blame individuals. Attach photographs where it is safe to take them.
4.Immediate actions
Record first aid given, whether the machine was tagged out, whether the area was made safe and who was notified. If the event is a notifiable incident the scene must not be disturbed until the regulator allows it.
5.Investigation and close out
The investigation will identify the immediate cause, the root cause and the control that failed or was missing. Corrective actions will be assigned an owner and a due date and the record will be closed only when they are verified.