Hazard and Incident Report Form
v3.0
Purpose. This form captures the first report of a hazard, near miss, injury, plant damage, environmental event or community complaint so that it can be entered in the Hazard and Incident Register and investigated.
1.When to use this form
Complete this form on the shift for any injury, near miss, high potential incident, vehicle interaction, isolation breach, plant or property damage, spill, dust or noise exceedance, community complaint or hazard you cannot fix on the spot. Report to your supervisor first and then complete the form.
2.High potential incidents
An event that could have caused a fatality or permanent disability, whether or not anyone was hurt, is a high potential incident. The supervisor must notify the site manager and the HSE and Training Manager immediately, preserve the scene and the plant, and the company will notify the regulator within the time the law requires.
- Vehicle interaction or loss of control
- Ground or highwall failure
- Explosives misfire or unplanned initiation
- Isolation breach or unexpected energisation
- Fall from height or into an excavation
- Fire on mobile plant or fixed plant
3.What to write
Write what happened in plain words in the order it happened, with the location, the plant and the people involved. Record what first aid or emergency response was given. Do not speculate on cause; the investigation will establish it.
4.Environmental and community events
For spills, record the substance, the volume and the containment. For dust, noise or blast complaints, record the complainant's account, the time and the weather and operating conditions at the time. These events must be logged the same day.
5.After submission
The supervisor enters the report in the Hazard and Incident Register and the HSE and Training team assigns an investigator and an initial risk rating within one shift. Corrective actions will be tracked to closure and reported at prestart.