Incident and Hazard Report Form
v2.2
Purpose. Anyone at the hub uses this form to report an injury, a near miss, a hazard, a spill, a broken item or an upset customer before the end of the shift.
1.When to use this form
Use this form for anything that hurt someone or nearly did, anything broken or unsafe, and any situation where a visitor or customer was aggressive. Use it even for small things like a cut finger or a wobbly chair. Fill it in before you finish your shift.
2.How to fill it in
Write in plain words what happened, where and when. Say who was there and what you did. If you are not sure how to spell something or what to write, ask your coordinator or trainer to help. You can also use the sign and symbol chart to point to the type of hazard.
3.What happens next
Give the form to your coordinator. The coordinator will add it to the Incident and Hazard Register within one working day and will tell you what will be done about it. You will not be in trouble for reporting.
4.First aid
If someone is hurt, get the first aid officer first and fill in the form afterwards. The first aid officer's name is on the board in each area.
5.Privacy
This form has people's names on it. Hand it to your coordinator, do not leave it on a bench and do not photograph it.