Health and Safety Form - Incident Report

In the event of an accident or injury

If an accident occurs that might have caused injury, or an actual injury occurs, there are several important steps to undertake. 1. Provide first aid and call for medical assistance as required. 2. Inform your supervisor of the injury. 3. In the event of a notifiable incident, the supervisor should notify WorkSafe Tasmania as soon as practicable by phoning 1300 366 322. This is a 24/7 phone number. Notifiable incidents include a) Death, b) Serious injury or illness; or Dangerous incident that may or may not have caused injury. 4. Do not disturb or clean up a site associated with a notifiable incident unless: - to assist an injured person, - to remove a deceased person, - it is essential to make the site safe or to reduce the risk of a further notifiable incident, - it is associated with a police investigation (who will make directions), or - an inspector or the regulator gives permission. 5. Inform the family and/or emergency contact of the injured person. Complete the form below and provide to supervisor. 6. A WorkSafe Tasmania Incident Notification Form ( ) must be completed and lodged within 48 hours of an incident.

PART A: Injured Person's Details


PART B: Details of Incident

PART C: Details of Person making notification

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