Ski Area User Notifiable Event Investigation

• JobSAFE Incident Number#

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

Name of Injured/affected person(s)

Incident Date

• Select date

  Date

Incident Location

• Photo of Site

  Media

Incident Description

Incident Detail

• Damage to Equipment?

  Yes

  No

• Injury sustained?

  Yes

  No

• Details of Injury and Treatment required.

• Environmental Impact?

  Yes

  No

Weather Conditions

Visibility

Surface Condtions

• Terrain Type

  Beginner

  Intermediate

  Expert

  Backcountry

Terrain Hazard Controls

• Is this Terrain Hazard identified at this location in Control Plan?

  Yes

  No

  N/A

• Risk Rating - as per terrain hazard control plan

  Green

  Yellow

  Orange

  Red

• Controls required as per Terrain Hazard Control Plan

  Select Signage Visual Physical Nil

  • Signage
  • Visual
  • Physical
  • Nil

• Controls in place appropriately at time of incident?

  Yes

  No

  N/A

• Photos

  Media

Follow up actions/ learnings

• Follow up Action:

• Action(s) complete?

• Completion Date:

  Date

Sign Off: Acceptance of findings and comments

• Safety Services Manager or Delegate (Whakapapa or Turoa):

  Sign

• Safety & Environmental Risk Manager or Delegate:

  Sign