Information
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Make the area safe and determine if assistance is required. You may need to ensure: Provide assistance to those injured or in danger DRSABCD Organise transport and appointment for personnel with medical practitioner accompanied by a Pindan Supervisor Contact Emergency Services for assistance Shut down or isolate Plant and Equipment Preserve the scene, restrict access or barricade area Start collecting initial evidence (statements, photos etc).
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Incident Date and Time
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Incident Reported Time and Date
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Branch
- Newman
- Carnarvon
- Geraldton
- Port Hedland
- Karratha
- Meekatharra
- Confidential
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Reported by
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Location
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Personnel invovled
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Witnesses
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Incident Details
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Please provide a title for the incident
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Please provide a brief description of the incident
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What task was being performed at the time of the incident
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Event Group
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What actions were taken after incident
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Work Stopped
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Personnel transported for Medical Assistance
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Emergency Services Called
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Area made safe
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First Aid Applied
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Supervisor Notified
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LIKELIHOOD of the incident occurring again
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CONSEQUENCE of the incident in worst case senario
Photos
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Please take photos of the incident - if its damage take a photo of the damage, if its an injury take a photo of what caused the injury etc
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Photo 2
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Photo 3
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Photo 4
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Photo 5
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Photo 6
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Drawing
Actions
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What learning did you get from the incident occurance
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What immediate actions could you take to prevent incident occurring again
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Do you have any other actions the business could implement
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Do you have any other actions the business could implement
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