Hazard & Incident Reporting DDA 005

• Document No.

Hazard & Incident Reporting DDA 005

• Conducted on

  Date

• Site/Department

• Lead Auditor

• Other Personnel Involved

• Do personnel know where to obtain a copy of the Hazard and Incident Report Form?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Have there been communications to personnel regarding the reporting of all hazards & incidents using the Hazard & Incident Report Form?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Are incidents as outlined in the policy being reported to SafeWork SA and the Office of the Technical Regulator?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Are managers/supervisors aware of the internal reporting process for notifiable injuries & dangerous occurrences?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Are hazards/incidents reported within 24 hours hrs of their occurrence? (Check dates on report)

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Is there a corresponding Hazard & Incident Investigation Form for each Hazard & Incident Report Form?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Has a corresponding investigation been undertaken by the relevant manager within 24 hours of receipt of the Hazard & Incident Report Form?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Has a Hazard Rating (where applicable) been assigned on the Hazard & Incident Report Form?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Have the Hazard & Incident Report Forms been assigned a Report Number & details placed on the Hazard/Incident Register?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Do personnel reporting hazards & incidents believe they have received appropriate management feedback?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Has Section 1 of the Hazard & Incident Report Form (where applicable) been fully completed?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Have sections 2, 4 & 5 of the Hazard & Incident Report Form been completed in full?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Has Section 3 of the Hazard & Incident Report Form (where applicable) been fully completed?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Is extra information as requested in Section 4 of the Hazard & Incident Report Form being supplied?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Are copies or the original Hazard/Incident Report Form held on file by the OHS Manager?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Do OHS Committee Meeting minutes reflect a review of all reported Hazards & Incidents?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Is there evidence of similar hazards/incidents having been reported in the last 3 months?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Is there evidence of contractors reporting hazards/incidents?

  Yes

  No

  N/A

• Observations/Comments and/or Corrective Actions including person responsible

• Add photo if required

  Media

• Lead Auditor Signature

  Sign

• Department/Area Manager Signature

  Sign

• OHS Advisor Signature

  Sign