LBT Incident, Hazard or Improvement Report
Use this form to report incidents that have occurred and for reporting hazards and improvements. If immediate First Aid is required there is a kit on the shelf just inside the LBT shed door. If you need First Aid instructions there are Fact Sheets at http://www.stjohntas.org.au/index.php/training/first-aid-fact-sheets/
Date *
When incident occurred or when a hazard or improvement was identified
MM
/
DD
/
YYYY
Location
Where did the incident occur? Where is the hazard? Where can improvements be made?
Your answer
Incident, Hazard or Improvement: *
What happened? What hazard have you identified? What improvement can you suggest?
Your answer
Immediate Response:
Your answer
Future Response:
What steps do you suggest to reduce the chance of a similar incident occurring again or for further reducing a hazard? What can LBT do to make further improvements?
Your answer
Who involved:
(Who was involved or can provide additional useful information?)
Your answer
Report prepared by: *
Your answer
Reviewed by:
LBT Committee member or someone nominated by the Committee
Your answer
Date of review:
MM
/
DD
/
YYYY
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