Class 1 (Major Incident)
Class 2 (Moderate - Lost Time, Medical Treatment etc)
Class 3 (Minor - first aid etc)
Details of incident (state facts only. What we know happened)
Part of body effected
Location of where incident occurred, relevant to construction site (e.g northern corner, outside site, second floor, scaffold etc)
Was worker taken to hospital after the incident?
Is the workplace regulator required to be notified of this incident?
Any action taken immediately after incident to prevent further incidents/injuries
Is an Investigation Report required to be completed by National EHS Manager? (Consult with EHS Manager)
Job title / trade:
Injured workers address:
Is there evidence the injured worker was inducted into the construction site?