Work Health and Safety Reporting

Your name

Date and time of report

Location of hazard

Type of problem

Urgent (e.g. high risk)
Health and Safety Issue
Security Issue
General Repair
Near Miss
Likely to Recur
Maintenance Needed

Description of the issue

What has been done about this issue?

has the hazard been removed? temporarily managed? who has been notified (e.g. groundsman, site leader etc)?

Did this hazard lead to an incident?

Yes
No

If yes, describe the extent of the incident

who was injured, was medical assistance or first aid required

Is a work cover claim likely as the result of an incident

Yes
No
N/A - no incident occured