WHS Near Miss & Incident Report Form

    Under the Work Health Safety Act 2011, a person conducting a business or undertaking must ensure, so far as is reasonably practicable, that workers are safe from injury and risk while at work.  Should a workplace near miss, incident or injury occur, Management must be notified as soon as reasonably practicable.  The purpose of this form is to document any hazard or incident which has occured whilst in the line of duty and to capture appropriate actions/s to prevent recurrence.

    Details of Incident

    Please ensure that you advise your supervisor/coordinator when a hazard or incident occurs.


    Details of Witness


    Incident Details

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    Injury Management Details

    Not applicable for hazard or near miss reporting


    Corrective Actions

    List corrective actions - complete or required for incident report.  If more corrective actions are required attach a Risk Management Control Action Plan.  The Corrective actions should be delveloped in consultation with your team leader & supervisor.

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