MCA Initial Incident Reporting Form
Must be completed and reported to the MCA HR Manager within 48 hours of the incident occuring.
Allianz First Report: Phone 1300 360 595
MCA Policy Number: MWF0011682
Name of person reporting
Date and time of the incident
Please be as accurate as possible
Casualty Full Name
Casualty Contact Number
Details of the Incident AND Injury Sustained
Please provide as much detail as possible including where the injury happened and what part of the body was injured.
Provide details of the treatment given
What action was taken?
What steps were put in place to prevent a recurrence?
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