Incident and Hazard Report Form
v2.1
Purpose. Workers complete this form to report an injury, near miss, hazard, vehicle incident or dangerous goods event before the end of their shift.
1.When to use this form
Use this form for every incident, near miss or hazard at any Corridor site or on the road. Complete it as soon as the area is safe and hand it to your supervisor, who will enter it in the incident register. For serious incidents, phone your supervisor first and complete the form afterwards.
2.Describing what happened
Describe the event in plain words in the order it happened. Include the plant, vehicle or product involved, the exact location such as aisle, bay or dock door, and the names of anyone involved or who saw it. Do not guess at causes; record what you saw and did.
3.Immediate actions
Record any first aid given, whether emergency services were called, what was done to make the area safe and whether the plant or vehicle was tagged out.
4.Supervisor section
The supervisor will review the report, add the register reference number, assess the initial risk rating and decide whether the incident is notifiable. The supervisor must sign the form and forward it to the Safety, Compliance and Training Manager within one shift.
5.Privacy
Personal information on this form is used only to manage the incident and meet legal obligations. The form is stored in the safety records folder and is not shared beyond the people who need it to act.