CCC Contractor event report

Contractor Event Reporting

If you require support with this form, please contact hswsupport@ccc.govt.nz

Business Unit*

Project / Site*

Company *

Name of Submitter*

E-mail address of submitter*

E-mail address of CCC Project Manager*

CCC Engineers Rep / Engineer to Contract

Contract No.*

Date of event*

Event Category*

Event Mechanism*

Notifiable Event?*

WorkSafe Notification Reference Number*

Details of Event*

Positive Observation*

Type of Injury*

Body part affected*

Injury / Illness Summary*

Treatment*

Days lost to injury?

Immediate Actions Taken*

Did emergency services attend?*

Severity Level (5x5 Risk Matrix)*

Attachments (Photos, Reports, Investigations)

Upload a File

Corrective / Preventative Actions*

Please verify that you are human*

In submitting this form I agree to my details being used and accessed by Christchurch City Council (Council) for the purposes of anaylsis and prevention of similar events. The information will only be accessed by necessary Council staff. I understand my data will be held securely in and will not be distributed to third parties in accordance with the Privacy Act 2020. I have a right to change or access my information. I understand that when this information is no longer required for this purpose, Council procedures will be followed to dispose of my data.

Event Details