Title Page
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Document No.
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Field Incident Report
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Dexus Property Group 452 Flinders Street Melbourne 3000
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Conducted on
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Prepared by
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Personnel
Part 1: Incident/ Hazard Details
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Category of Incident:
- Personal Injury
- Property Loss/ Damage
- Near Miss
- Hazard
- Environmental Incident
- Note Only
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Property Name:
- Dexus Property Group
- Other
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Is the Building Address 452 Flinders Street Melbourne 3000
Enter the Description in the field below:
Specific area where incident occurred
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- Car Park/ Access Road
- Tenancy
- Toilet/ Welfare areas
- Food Court
- Mall/ Foyer
- Roof
- Loading Dock
- Landscape areas
- Lifts/ Escalator
- Stairwell
- Plant room
- Other
CCTV
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Incident Captured on CCTV
Incident Type Information
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Incident Type
- Slip, trip, fall
- Person caught in: door
- Person caught in: plant
- Person caught in: lift
- Fall from height
- Hitting object with body part
- Flood
- Property Damage
- Being hit by moving object
- Stress
- Medical
- Illness
- Animal
- Insect
- Manual handling
- Fire
- Electric shock
- Electrocution
- Biological
- Assault
- Vehicle
- Death
- Environmental impact
- Chemicals and other substances
- Exposure to mechanical vibration
- Heat/ Radiation
- Other
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Slip, trip fall specific options:
- foodscuffs
- Beverages
- Steps/ Stairs
- Rainwater on floor
- Lack of barrier
- Slippery surface
- Uneven surface
- Tripped over object
- Poor lighting
- Other
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Hit by or hitting object specific options
- Automatic door
- Manual door
- Lift
- Plant/ Equipment
- Escalator/ Travelator
- Other Specify
Observations by author of Incident Report (e.g. Weather, clothing, floor surface conditions) Enter in the below field
Part 2: Personal Injury Details (to be completed when category of Incident is Personal Injury)
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Injured Persons Name:
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D.O.B:
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Gender:
- Male
- Female
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Telephone:
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Email:
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Occupation:
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Person/ Party Identifies as:
- Guest/ Visitor/ Public
- Dexus/ CBRE Employee
- Tenant
- Contractor
- N/A
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Address:
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Injury Location (body part):
- Head
- Face
- Eyes
- Teeth
- Finger/ Thumb
- Ankle
- Multiple/ Various
- Neck
- Back
- Chest
- Abdominal
- Leg
- Unknown
- Internal
- Shoulder
- Arm
- Wrist
- Knee
- Toe
- Other
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Nature of Injury:
- Contusion/ Bruising
- Burns
- Cuts/ Abrasions/ Lacerations
- Amputation
- Bites/ Sting
- Illness
- Fracture/ Dislocation
- Musculoskeletal (strain/ sprain)
- Other
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Type of Injury:
- First Aid only
- Fatality
- No Injury
- Lost Time Injury
- Medical Treatment Injury
- Non-work related
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Treatment/ Risk Controls Provided:
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Provided By:
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Treatment Type:
- First Aid only
- Incident/ Near Miss/ No injury
- Hospital/ Medivac/ Ambulance
- Medical Practitioner
- Fire Department (MFB, CFA)
- Refused
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Transportation (if required)
- Ambulance
- Private Vehicle
- Refused
- Other
Part 3: Property Damage Details (to be completed when Category of Incident is Property Loss/ Damage)
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Nature of Property Event:
- Electrical fault/ issue
- Fire alarm fault/ issue
- Lift fault/ issue
- Power outage
- Weather Damage
- Façade/ building damage
- Machinery/ equipment fault
- Damage- common area
- Security (theft, vandalism, unauthorised access)
- Fire
- Leak/ flood
- Damage- tenant area
- Vehicle accident
- Other
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Cause of Property Event:
- Chemical
- Electrical fault
- Machinery (fixed plant)
- External source
- Human agencies
- Extreme weather
- Other
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Tenancy Details (if applicable):
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Name of business contact:
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Telephone:
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Email:
Part 4: Environmental Incident:
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Nature of Environmental Incident
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Cause of Environmental Incident:
- Chemical
- Dust
- Machinery (fixed plant)
- Noise
- Tools/ Equipment
- Other
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Impact on Environment:
- Air quality decline
- Evacuation
- Soil/ ground contamination
- Water contamination
- Other
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Photos attached of scene/ damage (if appropriate)<br>If yes please attach in the below field
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Photos of Scene/ Damage (if appropriate)
Part 5: Witness Details (to be completed when possible)
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Witness declined:
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Witness Name:
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D.O.B:
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Gender:
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Telephone:
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Address:
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Describe relationship to Third Party (if any):
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Observations by witness (if any):
Part 6: Report Completion Details (must be completed for each form)
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Reported to (Dexus employee or Security)
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Date and Time Reported:
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Method of reporting:
- In Person
- In Writing
- Telephone
- Other
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Report Completed By:
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Full Name & Signature
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Escalated (if required)
Part 7: Corrective/ Preventative Actions (must be completed for each form)
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Short Term:
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Responsible Person:
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Long Term:
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Responsible Person:
Part 8: Checklist (must be completed for each form)
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Report needs to be provided to site asset management team
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Incident details need to be sent to Statutory Authority (Worksafe/ Workcover)
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Is an incident investigation required to be completed for this incident
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Additional Emergency Response:
- None
- Contractor attended
- Fire Department attended (MFB, CFA)
- Police attended
- Other
Please attach additional relevant information or documents, photographs, CCTV Footage, Floor Plans, Security Reports, Cleaning Contracts, and Contractor Agreements etc. as part of your report. This Report is provided as a matter of record only and is not an admission of liability on behalf of Dexus Property Group or its agents.
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Additional Notes (e.g. Follow-up Welfare call)