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?

MACHINERY & TOOLS (PLANT)

Is all plant provided with suitable safe guards on nip and crush points? If a hand or body part can contact a cutting blade or be crushed during the normal operation of a machine it does not comply with Endeavour’s guarding requirements

Do all pedestal drills have chuck guards fitted?

Are guards in position and in good condition?

Are the correct guards fitted to portable powered tools and fixed plant?

Can all equipment be effectively isolated to prevent inadvertent activation?

Are isolation and tagout procedures used when plant is maintained?

Is access to the operator’s position clear of obstructions?

Are all machinery controls clearly labeled?

Is task lighting for the plant adequate?

Does the operation of the plant expose other persons to risk? (E.g. items or projectiles into intruding into passageways)?

Does the plant produce excessive noise levels?

Is appropriate/nominated Personal Protection Equipment available and worn?

Are hand and power tools in good condition?

Is all pedestal-mounted plant securely anchored to the floor?

Is all pallet racking bolted to the floor?

GAS CYLINDERS, HEATING AND WELDING EQUIPMENT

Are all gas cylinders suitably restrained when being used ?(e.g. chained into the trolley)

Are hoses, gauges and hand pieces in good condition?

Is correct personal protective equipment provided and used?

Are all gas cylinders in current test? - Less than 10 years since last testing?

Are all compressed gas cylinders in good condition?

Are compressed gas cylinders stored in cool, well-ventilated positions, and not in a trafficable area?

Are all compressed gas cylinders, empty and full, stored upright with a restraining chain or other device around the body of the cylinder?

Are empty gas cylinders stored separately from full ones?

Does the storage area have signs to identify empty and full cylinders?

LOCKOUT STATION

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

Are “Danger” tags readily available to employees requiring them?

Are “Lockout use only” padlocks available for staff?

Are single phase electrical plug covers available?

Are 3 phase plug covers available? (if applicable)

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.?

HAZARDOUS SUBSTANCES / DANGEROUS GOODS 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?

Wire mesh provided under fragile roofs (sky lights)?

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

Fences and gates in good condition?

Perimeter security fencing in good condition?

Are all pipes, cables etc clearly marked?

Are all the pipe / cable markings 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 all line markings in good condition?

Do line markings suit current production requirements?

Are materials storage areas clearly defined?

Are marked aisles clear of materials and other items?

Is surface condition of walkways satisfactory?

Is surface condition of equipment operating areas satisfactory?

Is access controlled to hazardous operating areas?

TRAFFIC MANAGEMENT (OUTSIDE BUILDINGS)

Are parking restrictions being complied with?

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

Are there speed limit signs at all entrances to premises?

Are there Forklift In Use signs at all entrances to premises?

Are there Visitors etc. to report to office before entering workshop signs at all entrances to premises?

Are disabled parking bays clearly marked and signed?

Are all traffic management signs in good condition?

Are marking and road signage requirements being complied with?

Are pedestrian walkways clearly defined?

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?

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

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?

Have you identified any risk situations where PPE is required but not provided?

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

There have been no changes likely to affect lighting levels since the last lighting level survey?

Has conformity with standards been achieved? Refer to Occupational Hygiene Management Procedure (QP 4046).

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

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

NOISE

Are high noise areas and tasks clearly defined and signed?

Are correct hearing protectors for noise source available?

Are hearing protectors used as required?

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 appointed?

Has the monthly evacuation procedure been conducted and documented?

Is extinguishing equipment clearly visible and accessible?

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?

Is the first aid room clean and tidy?

Are MSDS for all hazardous substances on site available in the first aid room?

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?

FORKLIFT MANAGEMENT

Has the required monthly forklift training been conducted?

Are the forklift tyres in good condition?

Is all seat upholstery on forklifts in good condition?

Is the flashing light working?

Is the reverse audible alarm working?

Is the site forklift management plan up to date?

Are all forklift operating areas clearly signed?

Are all forklift controls clearly marked with their function?

Have all forklifts been serviced as per the manufacturer’s requirements?

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.