Incident Checklist

• Incident Title

• Conducted on

  Date

• Prepared by

• Location
  Address

Incident Details

• Incident Report to be filled out on Spotlight

• Incident Date/Time

  Date

Scene Management

• Make scene safe

  Yes

  No

  N/A

• Preserve scene

  Yes

  No

  N/A

Safety of People

• Ensure an ESO has been contacted to treat any injured persons

  Yes

  No

  N/A

Reporting of incident

• Type of Incident

  Select Medical Treatment Injury First Aid Treatment Near Miss Fire Property Damage Theft Hazard

  • Medical Treatment Injury
  • First Aid Treatment
  • Near Miss
  • Fire
  • Property Damage
  • Theft
  • Hazard

• Contact must be made to the nominated Superintendent by attempting to call on the phone

  Yes

  No

  N/A

• Ensure a voice message and/or text message is left on the nominated Superintendents phone

• A Text message/Email is adequate in this situation followed by a detailed incident report

• Notify Superintendent

• Time incident reported to Superintendent

  Date

• Media used to report to Superintendent

  Select Text Message Email Phone Call

  • Text Message
  • Email
  • Phone Call

If notifiable Incident

• Superintendent to notify relevant Statutory Engineer- Mining, Maintenance, or Electrical

  Yes

  No

  N/A

• Incident scene may need to be preserved until an inspector arrives at the site or earlier as directed by the Supervisor

  Yes

  No

  N/A

Evidence

• Inspect the incident scene and take notes<br>-What people were involved<br>-What equipment was involved<br>-What are the environmental conditions

  Yes

  No

  N/A

• Photography at the scene

  Yes

  No

  N/A

• Drug and Alcohol Test all personnel involved in the incident

  Yes

  No

  N/A

• Collect statements from personnel involved/witnesses

  Yes

  No

  N/A

• Fatigue assessment

  Yes

  No

  N/A

• Take copes of risk assessments, permits,SWP,etc

  Yes

  No

  N/A

• Take 5

  Media

• JHA

  Media

• Multi Work Permits

  Media

• Any other associated Permits

  Media