RSS Zero Harm Assessment Version 2

• Document No.1

• Zero Harm Incident Assessment

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Zero Harm Incident Assessment.

• Brand

• Site Name and Number

• Severity.

  1

  2

  3

  4

• Incident Type

• RSS Specialist name, time and date of assessment.

Details as per IMC/OCA or Pulse notification

• Summary.

• Actions

Establish contacts required to complete incident assessment.

• Ensure contact with DRS or Area Manager prior to site contact - Has phone call been made?

  Yes

  No

  N/A

At the Site

• Conflict point (Cause of conflict)

• Location in store

• Persons Involved.

• Describe conflict.

• Describe events prior.

• Describe events post.

Investigation of the Incident.

• Target reported by Name

• Any actions taken by person named above?

  No

  Yes

• 1st Responder, reported by name.

• Any actions taken by person named above?

  No

  Yes

• Duty Managers name

• Any actions taken by person named above?

  No

  Yes

• Store Managers Name.

• Any actions taken by person named above?

  No

  Yes

• Area Managers Name

• Any actions taken by person named above?

  No

  Yes

• DSR Managers Name.

• Any actions taken by person named above?

  No

  Yes

• Name of the person who reported incident to IMC.

• Any actions taken by person named above?

  No

  Yes

• Pulse name reported by.

• Any actions taken by person named above?

  No

  Yes

• Police, reported by name.

• Any actions taken by person named above?

  No

  Yes

• RSS, reported by name.

• Any actions taken by person named above?

  No

  Yes

Details Of.

• Notes taken at the time / Managers diary.

  No

  Yes

• Witness statements.

  No

  Yes

• Police attendance details?

  No

  Yes

• Did RSS investigator attended, if yes add details.

  No

  Yes

• Did Line Manager offer any support? If yes add actions.

  No

  Yes

• CCTV footage available? If yes add details, date, time and camera number.

  No

  Yes

• Medical attention required? If yes add details

  No

  Yes

• Pulse controls

  No

  Yes

Assessment of Incident Impact.

• Any injuries?

  No

  Yes

• Sick days as a result of the incident?

  No

  Yes

• Stress?

  1

  2

  3

  4

  5

• Customer involvement / witness?

  No

  Yes

• Trade loss/ productivity loss?

  No

  Yes

• Changes of duties required because of incident?<br>

  No

  Yes

• Has the incident created work satisfaction issues?

  1

  2

  3

  4

  5

• Has the incident effected career options?

  No

  Yes

• Family support?<br>

  No

  Yes

Analysis of the Current Controls

• Banning notice issued?

  No

  Yes

• Offenders ID communications?(was the offender known to the site, history, offender alerts)

  No

  Yes

• Staff re-training required?

  No

  Yes

• Police communication ?

  No

  Yes

• Customer service approach?

  No

  Yes

• Comparison of actions to documented Policy?

• Pulse controls?