ESV Incident Attendance Report

• Date

  Date

• Availability Officer

• Subject

Summary

• Include a brief summary of what occured

Background Information

• What time did you receive the call from TMC?

  Date

• MEC Contact

• Site Contact

• What time did you arrive on site?

  Date
• Site Location
  Address

• Incident E Number

• Additional information

Details of Relevant People on Site

• Victim/Operator Name

• Victim/Operator Phone Number

• Owner/Manager Name

• Owner/Manager Phone Number

• WorkSafe

  Yes

  No

  N/A

• Provide details of WorkSafe involvement.

• Police/Ambulance/Fire

  Select Police Ambulance Fire Department

  • Police
  • Ambulance
  • Fire Department

• MEC

  Yes

  No

  N/A

• Provide details of MEC involvement

• Additional Patrons

Evidence Found

• Summary of Evidence Found

• e.g. Clear evidenced was found to show that the farm machinery made contact with the SWER powerline, specifically that the contact was witnessed and photographed by ESV when attending the scene the following day after the incident.

• Details of Evidence Found

• e.g.
  • Minor damage to and arcing marks on the conductor at the contact location
  • Arcing marks on the tires of the sprayer
  • Arcing marks on the handrail of the sprayer stairs indicating the operator was holding this with his hand when he received the electric shock
  • Rear left sprayer tyre had deflated following the incident indicating likely damage from an arcing event
  • Victim’s co-workers stated that he was found unconscious a few metres from the cab of the sprayer, and that he received serious burns to his foot. These injuries are indicative of an electric shock.
  

Evidence Seized

• Provide details of any evidence obtained or seized.

Preliminary Findings

• e.g. Sprayer contacted SWER powerline in breach of section 612 of the Electricity Safety
  (General) Regulations 2019.

Finding #

• undefined

Further Investigation

• undefined

Next Steps

• undefined

Recommendations

• undefined