Incident Report - Brisbane Festival

• Document No.

• Conducted on

  Date
• Location
  Address

• Prepared by

• Personnel

Incident Type

• What type of incident?

  Injury

  Property Damage

  Near Miss

  Illness

Incident Details (Near Miss)

• Please enter incident details

  Property Damage Incident

• Description of incident:

• Add media

  Media

• Select date

  Date
• Add location
  Address

Incident Details (Property Damage)

• Please enter incident details

  Property Damage Incident

• Description of incident:

• Add media

  Media

Incident & First Aid Details (Injury or Illness)

• Add details of each individual person involved in the incident :

Person

• Full Name:

• Date of Birth:

• Gender

  Male

  Female

  Transgender

• Residential Address:

• Post Code:

• Phone:

• Email:

• What is the injured / ill persons role?

  Brisbane Festival Worker

  Member of general public

  Other

• Other (Please Specify):

• Brisbane Festival Employment Status

  Select Full-time staff Part-time staff Casual / Event Staff Contractor or Self-Employed Intern / Secondment Volunteer Artist / Company Member Other (Please Specify)

  • Full-time staff
  • Part-time staff
  • Casual / Event Staff
  • Contractor or Self-Employed
  • Intern / Secondment
  • Volunteer
  • Artist / Company Member
  • Other (Please Specify)

• Other (Please Specify):

First Aid

• Was First Aid required?

  Yes

  No

  N/A

• Describe illness or injuries (include location on body of all injuries):

• Describe First Aid treatment:

• Patient handover resulted in:

  Ambulance

  Own Transport

  Taxi

  No Further Treatment

• First Aid Officer:

  Sign

• Patient Signature:

  Sign

• Please enter incident details

  Property Damage Incident

• Description of incident:

Notifying Authorities

• One of the following people must be notified of every incident, other than those administering of minor First Aid:
  
  The Event Health and Safety Representative (Site Manager);
  WHS Coordinator Anne Boyd or
  Brisbane Festival's Health and Safety Representative (Chair of the Work Health and Safety Committee) Tim Pack.
  
  Workplace Health and Safety Queensland must be notified in the case of serious bodily injury, work caused illness or a dangerous event.
  
  If Police have been notified, enter the name of the police officer, station and date and time reported

• Select the authorities that have been notified:

  Select HSR / WHS Representative Workplace Health and Safety Queensland Police Other

  • HSR / WHS Representative
  • Workplace Health and Safety Queensland
  • Police
  • Other

• HSR / WHS Representative Full Name:

• HSR / WHS Representative Role (e.g. Site Manager):

• Police Officer Full Name:

• Date and Time Reported

  Date

• Police Station:

• If response was 'Other' Please enter details:

Action

• Has the potential for risk been resolved safely?

  Safe

  At Risk

  N/A

• Action taken:

• Action taken:

• Add media

  Media

Sign off

• Add name and signature:

  Sign