Incident, Hazard and Injury Reporting

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.

Completed the Incident, Hazard and Injury Reporting Form below.

Incident Reporting Form

Reported By

First Name

Last Name

Date of Report

Email

Phone

Incident Information

Incident Type

Incident Date

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Specific Area of Location

Incident / Hazard Description

Name | Role | Contact Details of Parties Involved

Name | Role | Contact Details of Witnesses Involved