Incident Report Form

A form for recording and reporting workplace safety incidents, such as injuries, illnesses, dangerous occurences and near misses.

Strongly recommended for all workplaces in Australia, this form helps you to meet your legal obligations to manage risks to health and safety. This is an important document for workplaces in all industries, inlcluding low risk workplaces. It contains all of the relevant fields to meet the requirements of a Register of Injuries (a legal requirement in NSW) and is suitable for use in all other states. This is a simple, clean, 4-page form that includes:

• Details of the injured person
• Details of the incident
• Identification of the contributing factors
• Incident follow-up
• Corrective actions
• Employer sign-off
• Information about notification to the regulator (if required)

It is important to record all safety incidents at your workplace, not just when someone was injured. This form can be used to record all kinds of incidents, including dangerous occurences (like spills, collisions, fires, electric shock or property damage), near misses, or instances of violence or aggression.