Title Page
-
Date
-
Availability Officer
-
Subject
Summary
-
Include a brief summary of what occured
Background Information
-
What time did you receive the call from TMC?
-
MEC Contact
-
Site Contact
-
What time did you arrive on site?
-
Site Location
-
Incident E Number
-
Additional information
Details of Patrons on Site
-
Victim/Operator Name
-
Victim/Operator Phone Number
-
Owner/Manager Name
-
Owner/Manager Phone Number
-
WorkSafe
-
Provide details of WorkSafe involvement.
-
MEC
-
Provide details of MEC involvement
-
Additional Patrons
Evidence Found
-
Summary of Evidence Found
-
E.G.: Clear evidenced was found to show that the farm machinery made contact with the SWER powerline,
-
specifically that the contact was witnessed and photographed by ESV when attending the scene the
-
following day after the incident
-
Details of Evidence Found
-
Minor damage to and arcing marks on the conductor at the contact location
-
Arcing marks on the tires of the sprayer
-
Arcing marks on the handrail of the sprayer stairs indicating the operator was holding this with his hand
-
when he received the electric shock
-
Rear left sprayer tyre had deflated following the incident indicating likely damage from an arcing event
-
Victim’s co-workers stated that he was found unconscious a few metres from the cab of the sprayer, and
-
that he received serious burns to his foot. These injuries are indicative of an electric shock.
Evidence Seized
-
Provide details of any evidence obtained or seized.
Photographs
-
Include relevant photographs.
Additional Details
Preliminary findings
-
EG Sprayer contacted SWER powerline in breach of section 612 of the Electricity Safety
(General) Regulations 2019. -
undefined
-
Further Investigation
-
undefined
Next Steps
-
undefined
Recommendations
-
undefined