Hazard Report
Hazard/Near Miss/Incident/Regulatory Visit-Audit
Site & Reporting Details
Site
*
CQLX
CRLX
CTLX
CVLX
HRLX
IRLX
NVLX
SELX
TRLX
WVLX
Head Office
Date
*
-
Day
-
Month
Year
Date
Time
*
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Hour
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Minutes
AM
PM
AM/PM Option
Person Submitting Report
*
Full Name
Company (if not RLX)
Status
*
Please Select
RLX Employee
Livestock Agent
Transport Driver
Trade Contractor
Labour Hire
Visitor
Who was this reported to
*
If not verbally reported, type N/A
Type of Report
What type of Report is this?
Hazard
Near Miss
Regulatory Visit/Audit
Incident - FAI/MTI/LTI
Environmental/Property Damage
Hazard Report
What type of Hazard is it?
*
Animal other than livestock
Biological
Buildings and Structures
Confined Space
Contact with Object
Driving/Traffic
Electricity
Environmental
Ergonomic
Extreme Temperatures
Fire Safety
Gravity (Slip\Trips\Falls)
Hazardous Chemicals
Hygiene
Livestock Interaction
Machinery & Equipment
Manual Handling
Noise
Procedural
Psycho-social
Radiation
Signage
Vibration
Describe the Hazard
*
Upload a photo or file (Optional)
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of
What immediate actions have been taken to make safe?
*
If 'nothing then write 'Nil.
Incident Report
What type of Incident occurred?
FAI
MTI
LTI
Property Damage
Environmental
FAI/MTI/LTI
Who did it happen to?
*
e.g. Name, DOB, address, contact number
Role/Company
Person Category
*
Please Select
RLX Employee
Livestock Agent
Transport Driver
Trade Contractor
Labour Hire
Visitor
Description
*
e.g. Injury description, treatment (icepack on-site/stitches) & where (site/hospital)
What happened?
What factors were involved?
*
Please Select
Commuting
Vehicular/Plant
Security
Animal Related
Escaped Animal
Weather
Describe incident & activity being undertaken
What has been done?
e.g. Actions taken to make safe
What PPE was worn?
*
Please Select
Head Protection
Chaps
Hand Protection
Torso/Chest/Rib Protection
High VIS
Eye Protection
Foot Protection (Steel Caps)
Type of footwear?
*
Please Select
Runners
Slip on Shoes
Lace up Shoes
Pull on boots
Lace up Boots
Injury details - side of body
*
Please Select
Left side
Right side
Injury details - body part injured
*
Please Select
Arm
Ankle
Finger
Foot
Hand
Head
Knee
Leg
Thumb
Toe
Torso
Wrist
Environmental/Property Damage
Name of person involved?
*
Role/Compnay
What factors were involved?
*
Please Select
Commuting
Vehicular/Plant
Security
Animal Related
Escaped Animal
Weather
Describe the incident & activity being undertaken
*
Describe damage that has occurred
Near Miss
Who was involved?
*
Role/Company
*
Person Category
*
Please Select
RLX Employee
Livestock Agent
Transport Driver
Trade Contractor
Labour Hire
Visitor
What happened?
*
Please include as much detail as possible
What type of Near Miss occurred?
*
Please Select
Security
Safety
Probable MTI/RWI
Probable LTI
Probable Fatality
Environmental
Property Damage
What factor were involved?
*
Please Select
Commuting
Vehicular/Plant
Security
Animal Related
Escaped Animal
Weather
Why did the event occur?
*
Describe the activity being undertaken
How did the event occur?
*
e.g. include other parties involved, weather or other conditions
Regulatory Visit/Audit
What Type of Audit?
*
Report initial Findings/comments
*
Image Upload (Optional)
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Cancel
of
Any Directions issued for action?
*
If 'nothing then write 'Nil.
Submit
Submit
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