(08) 8354 3122

    Type of Report - Hazard, Incident or Injury

    First and Last name

    Host employer

    Date and time of Hazard/Incident/Injury

    Site Address

    Location (e.g. Workshop floor)

    Have you informed your supervisor of this Hazard/Incident/Injury?

    Description (please include part of body if reporting an injury)

    What actions can be taken to prevent this happening again?