Title Page
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Document No.
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Client / Site of Event
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Report Time and Date
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Reported by
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Location
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Use this form to report any Near Misses, Accidents, Hazards, or Maintenance Issues onsite.
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Type of Event
- Near Miss
- Minor Harm
- Serious Harm
- Hazard Report
- Maintenance Issue
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What Happened? Describe what's wrong / has gone wrong. Give all relevant details. ie. Cut my hand on weedwacker while using it to trim grass
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What did you do next? What has been done about it already? Give all relevant details. ie. Bandaged it up using the first aid kit. Had some concerns about it being infected due to the state of property.
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What do you think SHOULD be done about it, to reduce/prevent additional or future injuries? Give all relevant details. ie. We need to replace the guards on the weedwackers - they often fall off while cutting.
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Additional Media (optional)
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Additional Information if required (optional)
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Click "Mark As Complete", then "Export Report" then send the generated PDF to chris@naileditsafety.co.nz via your email app. Any problems, give Chris a call 021594694 or complete a manual TWC Form.
