Information

  • Document No.

  • Simple Interiors Pty Ltd Injury Report

  • Prepared by

  • Your position

  • Contact details

  • Conducted on

  • Location

Incident must be reported immediately. If possible, pictures must be collected to submit to insurance or other parties. Report must be submitted to: Simple Interiors Pty Ltd 19/29 Governor Macquarie Drive Chipping Norton NSW 2170 P:97281184 E: info@simpleinteriors.com.au

Incident

  • Type of incident

  • Date of the incident

  • Submitted to Safety

Details of person involved

  • Name of party involved

Details of occurrence:

  • Address of occurrence

  • Street:

  • City:

  • State

  • Job No. If known

  • Describe the occurrence in detail

  • Was medical attention given?

  • Describe the treatment given and by whom

  • Was the person involved attended to by paramedics or transported to the hospital

  • Please describe

  • Please add any supporting photos

Accident Causes:

  • Indicate primary incident cause, and explain reason selected:

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