Incident, Hazard and Environmental Event Report Form
v2.2
Purpose. Workers use this form to report injuries, near misses, hazards, chemical releases, sewage spills, vehicle incidents and environmental events so they are entered in the register and investigated.
1.When to use this form
Use this form for any event that harmed or had the potential to harm a person, the environment, an asset or the water supply. Complete it before the end of the shift. If you are unsure whether an event needs reporting, report it. Sewage spills and chemical releases must also be phoned through to the control centre immediately so regulator notifications can be made in time.
2.How to complete it
Describe what happened in plain words and in sequence. Name the asset, chemical, vehicle or location involved, the weather and site conditions, and any permit in force. Record witnesses. Do not write opinions about fault. Hand the form to your crew leader or shift supervisor, who enters it in the WHS and Environmental Incident Register.
3.Environmental events
For a sewage spill or chemical release record the estimated volume, the start and stop times, whether it reached a waterway or stormwater drain, the containment and clean-up carried out and the samples taken. The control centre will notify the regulators.
4.What happens next
The department manager classifies the event, assigns a risk rating from the matrix in the Drinking Water Quality Risk Management Plan and decides whether an investigation is needed. You will be told the outcome and any actions.
5.Privacy
Personal information on this form is used only to manage the event, meet legal duties and improve safety, and is kept in the WHS file.