Information
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Zero Harm Incident No.1
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Site
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Division
- SMKT
- Petrol
- Dan Murphy's
- BWS
- Big W
- Masters
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Site #
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Conducted on
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Prepared by RSS Specialist -
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Personnel
Details as per IMC/OCA or Pulse notification
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Incident Type
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Severity rating by IMC
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Brief Summary as per Notification
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Actions or Updates as per Notification
Notify Site and Operations contacts required to complete incident assessment.
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Regional /Area Management
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Store Management
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Target Employee(s)
At the Site- targeted employee description of events
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Targeted Employees- employment role
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Conflict point (Cause of conflict)
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Location in store
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Describe conflict.
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Describe events prior.
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Describe events post.
Investigation of the Incident.
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Report added to Pulse
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Reported to IMC
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Reported to Police
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Note actions taken by target employee(s)
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Note actions taken by first responder(s)
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Note actions taken by Duty Manager.
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Note actions taken by Store Manager.
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Note actions taken by Area Manager.
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Note actions taken by DRS.
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Any actions taken by Police.
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Any actions taken by RSS.
Follow up Of Incident
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Is there any documentation related to the incident still available to view at the store?
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Were staff offered counselling
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Were notes taken at the time (eg Managers diary/RSA Incident register)
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Was CCTV footage recorded and burnt at the time
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Witness statements taken by Police
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Was the escalation of the incident appropriate given the severity?
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Note Line Manager/ others ongoing support? If yes add actions.
Assessment of Incident Impact.
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Was there any medical attention required?
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Was there any time off taken by the target employee(s) as a result of the incident?
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Did the incident create an increased level of stress for the targeted employee(s)?
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Were customers impacted by/ witness to the incident? How many customers?
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Was there any Trade loss? /Productivity loss?
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Did the targeted employee require a change in duties because of incident?<br>
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Has the incident impacted work satisfaction issues for the targeted employee(s)?
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Has the incident impacted further career options with WOW for the targeted employee(s)?
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Did the target employee(s) utilise Family support?<br>
Analysis of the Current Controls
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Did Police communicate any outcomes, further detail?
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Banning notice issued?
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Were Offenders ID communicated?
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Did the target utilise Converge?
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Was there a review of staff Customer service approach in this incident?
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Was there any formal re-training or counselling conducted?
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Do the actions of staff in this incident comply with current documented Policy?
