Incident Report Form
Type
*
Injury / Harm
Close Call
Hazard
Property damage
Things that went well
Environment
Audit
Business Quality
Abusive Guest
Description (What/How)
*
Source of incident (what was the activity being undertaken at the time?):
*
Lift related
Road vehicle
Oversnow vehicle
De-icing
Machinery or moving parts
Snow removal (shovelling/snow blowing)
Skiing or riding (at work)
Work at Height
Slip, trip or fall on icy surfaces
Falling objects
Fatigue
Hazardous Substances
Drinking Water System
Effluent (sewage) System
Compliance / certification breach
Other
When did this happen
-
Day
-
Month
Year
Where did this happen
*
Your name
First Name
Last Name
Main person involved
First Name
Last Name
Person type
*
Staff
Guest
Contractor
N/A
Main department involved
*
Please Select
Events
Finance
Food & Beverage
General Managers Group
Grooming & Terrain Park
Guest Relations
Human Resources
IT
Lift Operations
Maintenance
Marketing & Sales
Medical Centre
Rentals
Retail
Road Operations
Safety & Environment
Safety Services
Ski & Ride School
Snowmaking
Area
*
Tūroa
Whakapapa
Other
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Injury type
*
Crush / Impact
Bruising
Strain / Sprain
Scratch / Abrasion
Fracture / Break
Amputation
Cut / Laceration
Burn / Scald
Dislocation
Internal Injury
Foreign body
Allergic Reaction
Penetration
Mental Health / Stress
Other
Body part
*
Head
Upper Limb
Torso
Lower limb
Back/spine
Face
Other
Injury response
*
None
First Aid only
Medical attention
Emergency services
Injury outcome
*
Return to work
Alternative duties
Time off
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What's been done to sort out the situation and / or prevent it from happening again?
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