Incident and Near miss Register
Client / Site *
Name of person (injured or observer) *
Details *
Description of accident/incident/near miss, type of injury/disease (if any).How did it happen? (briefly).
Your answer
Immediate action taken? *
Yes
N/A
First aid
Corrective action
Update/ review hazard register
Review hazard register
Does this incident require a WorkSafe notification? *
Should this incident be investigated by your company (PCBU 2 )? *
Is this incident the subject of a tool box talk? *
Submit
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