Workplace Incident / Injury / Illness Report Instructions
Step 1: Incident Report Form
- This form MUST be completed for all incidents / injuries / illnesses
(including near misses) by the person involved / Supervisor / Manager.
If the person is taken for medical treatment the Supervisor / Manager is
to provide as much information as available.
- For a near miss incident the Injured Employees Details and Injury Details are not required i.e. when no injury has occurred.
- A BLH Statement (BLH-HSE-FRM-0130) is also to accompany this report
and shall be taken where an incident / injury / illness occurs,
including near misses.
- For injuries and any incidents requiring medical attention, the
injured person's direct Supervisor / Manager must notify the HSE Manager
as soon as possible.
- Injured employee / person involved in incident to fill out front
page only. Investigation to be completed after receipt of report and to
be completed by HSE Manager or delegate (Supervisor / Manager). To save
- file in Employee Folder under OHS Incidents as well as Client folder
under OHS Incidents.
Step 2 Incident Investigation Form
- The Incident / Injury / Illness Investigation form is to be
completed for all incidents asap. Where possible, The HSE Manager will
be involved in the investigation of all LTI and injuries requiring
outside medical treatment.
- The investigation is to be completed by the HSE Manager or delegate
in conjunction with the injured person, any witness, and any other
parties deemed appropriate.
- When selecting appropriate corrective actions the Hierarchy of
Control is to be considered. The highest level of control that is
reasonably practicable is to be implemented.
- These controls are Elimination, Substitution, Isolation,
Engineering, Administrative, Personal Protective Equipment. Examples are
- Elimination - remove the hazard
- Substitution - may be substituting a hazardous chemical with a non hazardous chemical
- Isolation - is isolating the individual from the hazard - barriers/ engines in insulated rooms
- Engineering Controls - stop switches/ guarding/ barriers/ additional valves
- Administrative Controls - procedures/ training/ disciplinary action
- PPE - Personal Protective Equipment. Should be used in conjunction with other controls
- The completed form is to be emailed or forwarded to the HSE
Manager. Copies are to be placed on the BMS under respective client
folder and HR personnel File (involved party).
- The HSE Manager is to allocate responsibility for ensuring all
identified corrective actions are implemented within the agreed
- Once all corrective actions have been implemented this is to be
acknowledged on the Incident Investigation Form and filed for recording
- For any queries regarding this report form, please consult your Manager or the BLH HSE Manager on 0409 694 324.