Incident Report Thank you for connecting with us. We will respond to you shortly. 11https://ausdigi.com/wp-content/plugins/nex-formsfalsemessagehttps://ausdigi.com/wp-admin/admin-ajax.phphttps://ausdigi.com/incident-reportyes1fadeInfadeOut Incident / Hazard Report FormSafety in the workplace is a shared concern between all parties. In the first instance seek medical treatment where required - even if you are unsure !Following any incident or finding a hazard you should immediately report the incident or hazard to your employer or company supervisor, and also to AusDigi, or within 24 hours if this is not possible.If equipment is found to be faulty, unsafe or in poor condition, this must be flagged immediately and removed from service provided this can be done safely. If electrical, turn it off at the fuse before removing or touching the equipment and/or contact an electrical engineer to remove the equipment safely and have it tagged out for you.For other hazards, ensure you photograph the hazard, include it in your SWMS and take 5 observations and report the problem immediately.NB : A separate form should be filled out by each and every person involved in an incident or affected by hazards.Please fill in all fields below :*Name of Person involved in the Incident*Date of incident*Time of incident*Incident reported to (please list all names) to investigate*Task being performed at time of incident*Description of the incident*Had the required "Take 5" been undertaken prior to commencing the task ?--- Select ---YesNo*Had an SWMS been prepared prior to undertakling the task ?--- Select ---YesNo*What Factors Contributed to the Incident ?.Noise.Lighting.Vibration.Damaged/Unstable Floor.Layout/Design.Dust/Fumes.Slip/Trip Hazard.Incorrect Equipment for the Job.Inexperienced Operator.Inadequate Maintenance.Equipment Failure.Inadequate Guarding.Materials/Equipment too Heavy.Inadequate Training.Incorrect Harness Setup.Unsafe Ladder Usage.Other (Please describe below)Contributing Factor(s) if "Other"*Work Systems.Hazard not Identified.No/Inadequate Safe Work Procedure.Hazard not Reported.No/Inadequate Risk Assessment Conducted.No/Inadequate Safety Controls Implemented.Inadequate Training/Supervision.Procedure not Followed.Procedure does not Exist.Fatigue.Change of Routine.Lack of Communication.Drugs/Alcohol.Time/Production Pressures.Distraction/Personal Issues/Stress.OtherWork Systems Contributing Factor(s) if "Other"*Corrective Actions - please identive what corrective actions will take place (describe in detail) :*Who will implement these Corrective Actions (multiple persons can be included)*When will these Corrective Actions be ImplementedFollow Up*Did the Incident require Medical Treatment ?--- Select ---YesNoName of Person who required Medical Treatment (if applicable) :Decsription of Medical Treatment and Outcome (in detail)Upload copies of Medical Report and Test Results from Medical Professional(s) X doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx,jpg,jpeg,png,psd,tif,tiff Name and Contact Detaols of Medical Professional(s) who supplied Treatment or ObservationOther Imporant Notes relating to Treatment or Medical CareResolution*Has the Incident or Hazard issue been Resolved--- Select ---YesNoIf Unresolved, what steps are being taken to resolve the issue(s) ?If Resolved, what steps were taken to resolve the issue and prevent it from happening again ?Name of Person who reported the Incident or HazardSignature of Person reporting the Incident or HazardDateSignature of Person involved in the IncidentDateSubmitIncident Investigation Process Guide1. Establish the facts of the incident, including:- What happened? - When and where did it happen? - What task was being done? - Who was involved? - Were there any witnesses? 2. Gather all necessary background information, for example: - maintenance records - safe work procedures - instructions manuals - training records. 3. Consider all the potential contributing factors: - Environment: Did environmental conditions (e.g. light, noise, floor surfaces) contribute to the incident? - Equipment /materials: Did anything about the equipment, materials, tools etc (e.g. equipment failures, missing guards) contribute to the incident? - Work systems: Was there something about the system that contributed (e.g. hazard not identified, known hazard not addressed)? - People: Was there something the workers, supervisors or contractors did that contributed to the incident (e.g. poor communication, being tired or rushing to finish on time)? 4. Determine the primary cause/s of the incident, that is, those which if they hadn’t occurred then the incident wouldn’t have occurred. Ask yourself “Would the incident have happened if….?” 5. Identify the root cause / system failures that underlie the primary cause/s and contributing factors. One simple technique for identifying the root cause is the ‘Five Whys’. This technique involves asking yourself ‘Why did this happen?’ and continuing to ask ‘Why’ for each response until you reach a conclusion that does not generate another ‘why’ and the underlying cause becomes apparent. 6. The final and most import step in any investigation is to take action to fix all the factors that contributed to the incident, starting with the primary cause/s and working through each of the contributing and underlying causes.
