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

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