Title Page
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Year
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Fantail H & S Representative: Erik Potgieter
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Fantail H & S Contact Number: 021 249 3563
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Document Number
Accident and Corrective Action Register
- Description
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Date of Incident
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Person Involved
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Reported By
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Site Name/Location
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Description of Accident/Incident
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Immediate Action Taken
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Property Damaged
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Body Parts Injured
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Type of Injury
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Type of Incident
- Falls From Height
- Falls From Same Level (Including Trips and Slips)
- Other Muscle Stress
- Hitting Objects With Part Of The Body
- Exposure To Part Of The Body
- Exposure To Mechanical Vibration
- Being Hit By Moving Objects
- Exposure To Sharp Sudden Sounds
- Long Term Exposure To Sounds
- Exposure To Variations In Pressure (Other Than Sound)
- Repetitive Movement With Low Muscle Loading
- Contact With Electricity
- Vehicle Accident
- Contact With Or Exposure To Hot Or Cold
- Single Contact With Chemical Substance (Excluding Bites and Stings)
- Long Term Contact With Chemicals Or Substances
- Other Chemical Substances Including Insect Bites And Stings
- Contact With Or Exposure To Biological Factors
- Exposure To Mental Stress Factors
- Exposure Radiation
- Slide Or Cave In
- Other Mechanisms Of Injury
- Unspecified Mechanism
- To Be Confirmed
- Near Miss
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Time Lost
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Full Incident Completed
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Further Action Required/Follow Up Required (If yes, add notes)
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Corrective Action to Remedy/Comply
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Notifiable Incident
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Has the incident been reported to Work Safe?
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Work Safe Reference/Details
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Status
