MONTHLY INCIDENT/ACCIDENT REPORTING (Financial Year figures)

Instructions

1. Fill out the required details in the space given, then go the next sections to answer the questions provided.
2. Add photos and notes by clicking on the paperclip icon.
3. To add a Corrective Action click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
4. Complete audit by providing digital signature.
5. Share your report by exporting as PDF, Word, Excel or Web Link.

CLASS 1
Death, loss of body part, absence from work for 4 days or more

Have there been any Class 1 Injury?

Class 1 first aid treatments
- Work caused Injuries

Year to date

Total this month

Total year to date

Class 1 first aid treatments - Non Work Injuries.
(Treatments for injuries that occurred outside of work hours)

Year to date

Total this month

Total year to date

Class 1 First Aid treatments - Non Work Injuries
(Treatments for injuries that occurred during work hours as a result of a persons disability not the work environment)

Year to date

Total this month

Total year to date

Give brief description of each injury and the causal factors:

CLASS 2
Lost time up to 4 days including time off work for external medical treatment

Have there been any Class 2 Injury?

Class 2 first aid treatments
- Work caused Injuries

Year to date

Total this month

Total year to date

Class 2 first aid treatments - Non Work Injuries.
(Treatments for injuries that occurred outside of work hours)

Year to date

Total this month

Total year to date

Class 2 First Aid treatments - Non Work Injuries
(Treatments for injuries that occurred during work hours as a result of a persons disability not the work environment)

Year to date

Total this month

Total year to date

Give brief description of each injury and the causal factors:

CLASS 3
Minor First Aid, No lost time due to injury.

Have there been any Class 3 Injury?

Class 3 First aid treatments
- Work caused Injuries

Year to date

Total this month

Total year to date

Class 3 First aid treatments - Non Work Injuries.
(Treatments for injuries that occurred outside of work hours)

Year to date

Total this month

Total year to date

Class 3 First Aid treatments - Non Work Injuries
(Treatments for injuries that occurred during work hours as a result of a persons disability not the work environment)

Year to date

Total this month

Total year to date

Give brief description of each injury and the causal factors:

HAZARD IDENTIFICATION (HIR PROCESS)

Have any new HIRs been raised this month?

HIRs (Click on "Add HIR")

HIR

HIR NO.

Date HIR raised

Details of hazard identified

Hazard controlled

Are there any outstanding HIR’S from previous months?

HIRs (Click on "Add HIR")

HIR

HIR NO.

Date HIR raised

Details of hazard identified

Hazard controlled

COMMENTS ON OUTSTANDING HIRs

AUDIT

OFFICE & SECURITY HAZARDS

Are the offices clean and tidy?

Are there sufficient rubbish containers?

Are all chairs and office furniture in good condition?

Are floor coverings in good condition?

Are all windows and doors in good condition and operating properly?

Are all windows, walls etc. clean?

There are no electrical leads lying on the floor that may cause trip hazards?

Are all globes and florescent tubes in working condition?

Security has not been breached?

There has been no interference to the building or structures on the premises?

LOCKOUT STATION

Are “Out-of-Service” tags readily available to employees requiring them?

Are “Lockout use only” padlocks available for staff?

Are single phase electrical plug covers available?

PORTABLE LADDERS AND PLATFORMS

Are ladders/platforms in good order and repair?

Are legs or ladders/platforms always locked in the fully open position?

Are ladders being used on level, stable ground?

Are the top 2 steps of any ladder being used?

Are extension ladders used at the correct angle and tied towards the top.

Are defective ladders tagged ‘Out of service’?

ELECTRICAL HAZARDS MANAGEMENT

Are flexible electrical cords run through holes in walls, ceilings or floor?

Are extension cords used where fixed wiring is required?

There are no double adaptors in use anywhere in the service? (these are banned in all Endeavour workplaces)

There are no extension leads lying on the floor in work areas so as to cause trip hazards etc.?

Are inspection tags fitted to all portable electrical equipment and are your test and tag up to date?

Is the register of portable electrical equipment up to date? (Test and Tag Register).

Are electrical isolation procedures established and used during electrical maintenance?

Are all electrical appliances and leads in good physical condition?

Are (RCD)’s tested? ( 6 monthly by pushing test button(s) and recording results and each 12 months by a COMPETENT PERSON)

Are electrical control boards obstructed by plant, equipment, stock etc.?

CHEMICAL MANAGEMENT

Have MSDS been obtained for any new chemicals / substances purchased during the month?

Are MSDS available at point of use for all substances identified as hazardous / dangerous?

Are MSDS available at point of storage for all substances identified as hazardous / dangerous?

Are all substances / chemicals stored together identified as compatible with each other in the storage situation?

Is the chemical store area clean and free from spills?

Are all chemicals / substances clearly labeled?

Are all chemicals that have been decanted into smaller containers clearly labeled?

Have all chemical / substance spills that have occurred in the workplace been effectively cleaned up?

BUILDING, STRUCTURES AND FENCES

Are roofs, gutters, and down pipes in good condition?

Is building cladding firmly attached and in good condition?

Are doors and locking devices in good condition?

Are emergency exit doors able to be opened from the inside without the use of a key in the case of an emergency?

Do doors operate easily, do not require excessive force?

Windows, louvres and skylights not broken and in good condition?

Fences and gates in good condition?

Are all pool safety requirements in place and in compliance with the local regulations?

Perimeter security fencing in good condition?

Are all signs on buildings and fences in good condition?

ASBESTOS MANAGEMENT

Is the Asbestos Register located in the immediate vicinity of the visitors register? (This is a requirement if Asbestos Containing Material is present at the site)

There has been no work carried out on asbestos containing material this month? (Record full details below in the notes section of all asbestos management work undertaken)

Has this work been recorded in the Asbestos Register? (This is a legislative requirement)

Is asbestos notification signage located at the entry to all buildings containing asbestos?

There is no asbestos containing material that needs attention? (i.e. painting, removing etc) List details of this in the comments.

Are risk assessments current for the asbestos hazards associated with your buildings? (Note: Risk assessments MUST be reviewed every 12 months or when work on asbestos containing material is carried out)

PERSONAL HYGEINE & EMPLOYEE AMENITIES

Are the amenities clean?

Are the amenities free from rubbish?

Are there sufficient rubbish bins?

Is there adequate vermin control?

There are no taps dripping?

No hand basins are cracked?

Are all windows clean and not broken?

Are electrical appliances in good condition (i.e. microwave)?

Are supplies of toilet paper, soap etc adequate?

TRAFFIC MANAGEMENT (INSIDE BUILDINGS)

Are aisles and walkways clearly defined and adequately marked where needed?

Are storage areas clearly defined?

Are marked aisles clear of materials and other items?

Is surface condition of walkways satisfactory?

Is access controlled to storage and office areas? (e.g. signs to indicate no entry except to authorized persons)

TRAFFIC MANAGEMENT (OUTSIDE BUILDINGS) This section only applies to Endeavour controlled areas.

Have entrances and access ways that have traffic travelling in both directions got directional arrows painted to indicate the directions of traffic?

Are all traffic management signs in good condition?

Are walking surfaces in a satisfactory condition?

Are driveway and parking surfaces in good condition?

HOUSEKEEPING

Is there clear access to workstations for material?

Is the working space adequate?

Are marked aisles clear of materials, pallets or other obstruction?

Are scrap bins provided and used?

Is there regular sweeping, cleaning and emptying of bins?

Are storage facilities provided for brooms, mops, hoses and workstation tools?

Are emergency exits free from obstructions for a distance of 2 metres either side of the doorway? (At all times)

Are material, tools equipment and other items stored securely and in an orderly manner?

Are external grounds, gardens and buildings in good order and well maintained?

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Is the appropriate PPE readily available to employees?

Is the required PPE being used?

Is PPE being properly maintained in dust and insect-free condition?

Is the PPE storage area clearly signed and visible?

Do injuries recorded in the first aid records indicate a need to review the provision or wearing of PPE?

Where applicable, is all PPE within the ‘Use-by’ Date?

LIGHTING

Has conformity with standards been achieved?

Are windows, translucent panels and light fittings clean and free from obstruction?

External artificial area illumination is adequate for safe pedestrian, machinery, transport movement?

VENTILATION

Is general area ventilation satisfactory?

Are air conditioning units in good working order?

Are air conditioning filters cleaned and replaced as required? ( at least 6 monthly)

Are the air conditioning maintenance registers up to date? (Each air conditioning unit requires its own maintenance register)

FIRE & EMERGENCIES PREPAREDNESS

Do emergency procedures adequately cover identified fire and explosion risks?

Is the evacuation plan displayed clearly in all buildings

Have fire wardens been identified (displayed on Workplace Health and Safety Contacts (QF4100.02)?

Has the 3 monthly evacuation procedure been conducted and documented?

Are fire extinguishers and hoses, carrying current inspection tag?

Is access to fire equipment free and unobstructed?
(A minimum of 900mm must be maintained around all extinguishers and hose reels)

Are fire alarms tested regularly (check logbook)?

Are exit signs in appropriate locations (No roller doors)?

MEDICAL EMERGENCIES PREPAREDNESS

Is the first aid kit(s) clean and tidy?

There are no non-allowable items in the first aid kit?

There are no items in the kit that have passed their use by date?

Is the first aid register being maintained as required?

Are the names of designated first aid officers clearly signed in all buildings? Workplace Health & Safety Contacts (QF 4100.02).

Have all designated first aid officers maintained competency?

Completion
Name and Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.