• Incident/Injury/Near-Miss Report

  • To ensure accurate and timely reporting and follow-up to any incidents, near misses, or injuries that occur on site, please ensure this report is completed and submitted no later than 24 hours following the incident.

  • Report Type*
  • Format: 0400-000-000.
  • Date and Time of Incident/Injury*
     - -
  • Did the colleague lose any working hours as a result of the injury - such as; going home early, and/or, having an additional day off?*
  • When is the colleague's next shift supposed to be?*
     - -
  • Was there a cost involved as a result of this Incident or Injury?*

  • In certain situations the incident, injury or near-miss is deemed a "Notifiable Incident" and must be reported to SafeWork.

    A notifiable incident is: The death of a person, a serious injury or illness, or a dangerous incident that exposes someone to a serious risk, even if no one is injured.

  • Is this a "Notifiable Incident" required to be reported to SafeWork?*
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
  • Format: 0400-000-000.
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  • Should be Empty: