A notifiable workplace incident is any event that exposes a worker or any other person to a serious risk to that person’s health or safety, and it requires the relevant health and safety regulator to be notified.

It may also include a ‘near miss’ where no actual injury occurs, but a danger is alerted.

Incident, Hazard and Injury Reporting Form

PART A

INCIDENT / HAZARD / INJURY INFORMATION
Address *
Address
Suburb
State
Postcode

NAME / ROLE / CONTACT OF PARTIES INVOLVED

NAME / ROLE / CONTACT OF WITNESSES

Optional Feedback Forms are available for download below:

Incident Reporting Form Client (WORD)

Incident Reporting Form Client (PDF)

Download fill out and return via email to info@trustedhomecare.com.au

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