- Near Hit
- Property Damage
- Hazard Advice
- Safety Infringement Notice
- Environmental Incident
Is this a Notifiable Event?
Meaning of 'notifiable event' - In this Act, unless the context otherwise requires, a notifiable event means any of the following events that arise from work:
(a) the death or a person; or
(b) a notifiable injury or illness; or
(c) a notifiable incident.
Has Worksafe NZ been notified?
Estimated number of lost days?
Name of injured person
Age of injured person
Gender of injured person
Is the injured person trained for task?
How long employed in the industry?
How long employed in this job?
Describe the injury - include left / right and front / back if applicable
- Getting in and out of cab
- Breaking out - outhaul and walk in
- Breaking out - retreat and haul in
- Breaking out -stropping
- Extracting logs
- Manual tree falling
- Mechanised Tree Falling
- Fleeting / sorting / stacking
- Hauler driving
- Hauler setup / shifting
- Line rope / shifting
- Log processing / skidwork
- Rope renewal
- System change
If 'Other', what activity or task was being done at the time?
What happened? Describe the incident (eg. rolled skidder, branch hit me, skidded off road, fuel spill). The more information the better.
Main / secondary causes of the incident
Lack of concentration, lack of communication, improper position for task, work area layout / congestion, unsafe work method / procedure, lack of experience / training / knowledge, weather / wind, lack of supervision / guidance, fatigue / dehydration, ground conditions / undergrowth, poor visibility, working too close (SWZ), defective machinery, hazard not identified, improper use of machine / vehicle, gear - PPE / footwear / eyewear, other
Describe the main cause of the incident (e.g. being outside the safe area, failed to notice hazard, tired)
Describe any secondary (underlying) causes
What has been / can be done to stop the incident happening again? (e.g. Hazard eliminated, new PPE)
If faced with the same situation again now, what actions would be taken differently?
Has the incident been discussed with supervisor, crew, employee?
Who was the incident discussed with and when? (e.g. date and was it morning tailgate, monthly meeting, one-on-one etc)
Incident report completed by