Information
-
CBE-OHS-006
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
incident report
-
Type of incident
- injury
- illness
- environmental
- property damage
- theft
- dangerous event/ near miss
- death
-
Name of Person involved.
-
Contact details (phone, address, d.o.b.)
-
Company name & occupation
-
Date & time of incident
-
Address & location of incident
-
Medical treatment
-
Details of any plant/ vehicles involved (rego, make/model, drivers details)
-
What happened? Insert details here
-
Insert photos
-
Witness details
-
Witness signature
-
Person involved signature
-
Person investigating signature
investigation
-
Root cause / contributing factors
-
Reported to ESO / WHS?
-
Was there a risk assessment for this specific task?
-
Insert photo of risk assessment
-
Was the person involved trained in this task & signed risk assessment?
-
Any other supporting documentation? (swms, toolbox, prestart, etc)
-
Was the person involved inducted to site.
-
Corrective actions/ preventative measures (list here)
-
Investigating officer signature
