Hazards, Incidents & Concerns
Subcontractor Form
Name of person completing the report
*
First Name
Last Name
Subcontractor Company
*
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Date
*
-
Day
-
Month
Year
Date
Time
*
Hour Minutes
AM
PM
AM/PM Option
Sci-Fleet Motors Location
*
Please Select
Brendale Toyota
Brendale Pre-Delivery
Coopers Plains Hino
Eagle Farm Hino
Fortitude Valley Lexus
Indooroopilly Lexus
Indooroopilly Toyota Used
Kedron Head Office
Kedron Toyota Used
Kedron Toyota New
Maroochydore Lexus
Nerang Hino
Southport Lexus
Springwood Lexus
Taringa Toyota
Torque Auto Body
Where did this occur?
*
What is the report type you want to submit?
*
Concern
Hazard
Incident
Back
Next
Concern
General concern or opportunity for improvement
Please leave a detailed explanation of the concern or opportunity for improvement you want to raise:
*
Thank you for raising your concern with us
Hazard
Potential to cause harm or damage
Description of the hazard:
*
Your immediate or recommended action:
*
Has this been raised with management on site, or have you contacted the Compliance team directly?
*
Yes
No
Thank you for brining this to our attention
Incident
Accident, incident and near miss
Name of injured person
*
First Name
Last Name
Phone Number of injured person
*
Please enter a valid phone number.
Type of Incident
*
Strain
Burning
Disease
Struck
Slip or trip
Electrocution
Fall from height
Poisoning
Explosion / Collapse
Inhalation
Equipment damage
Other
Other description:
*
Agency of injury, illness or occurence
*
Moving Equipment
Static Equipment
Hand Tools
Powered Hand Tools
Manual Handling
Electricity
Working Environment
Transport
Steam
Plant
Building & Structure
Gas
Trench / Excavation
Other
Other description:
*
Medical Treatment Required?
*
Nil
First Aid
Doctor Only
Admitted to Hospital
Using the above diagram, explain the nature and location of injuries
*
Where and how did injury, illness, occurrence happen? Include any further information:
*
Please upload any photos or further documents
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