Title Page

  • Report Reference Number (only enter if known)

EVENT DETAILS

  • Relates to:

  • Event Type:

  • Enter a Date and Time

  • Location/Kilometres

EVENT DESCRIPTION AND ACTION TAKEN

  • Description:

  • add photos

  • Immediate Actions/Controls taken/Solutions identified:

  • Fatal & Severe Risk

  • Reported by:

  • Team / Project:

CORRECTIVE ACTIONS

  • Corrective Actions, by whom and due date:

CONFIRM NOTIFICATIONS COMPLETED (where required)

  • Network Control (TCR #): or NA

  • Injury (Injury Hotline Ref # / Employee Notification): or NA

  • External (eg Environment, WHS) or NA

INITIAL CLASSIFICATION

  • Event Severity

  • Injury Classification:

  • Environment Non-Conformance Type:

  • Leader Approval (name):

  • Team/Project:

  • Date & Time:

Submit completed forms, including any attachments (photos, documents) to:

  • (Hunter level 1/2/3) internalincidentalert@artc.com.au (Hunter level 4) hv-sct@artc.com.au

  • (Inland) inlandrailsafetyteam@artc.com.au

  • (Interstate) hazard@artc.com.au

  • (Other) safetymatters@artc.com.au

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.