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INCIDENT NOTIFICATION FORM - WorkSafe Victoria - worksafe vic gov 2025

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The document is an Incident Notification Form from WorkSafe Victoria, outlining the requirements for reporting workplace incidents under the Occupational Health and Safety Act 2004 and Equipment (Public Safety) Regulations 2007. It details the necessary information to be submitted, including personal details of the person reporting, specifics about the incident, and any injuries sustained. Immediate notification is mandated for serious incidents, with a written record required within 48 hours. The document also emphasizes site preservation until an inspector arrives.

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Click ‘Get Form’ to open the INCIDENT NOTIFICATION FORM in our editor.
Begin by entering your Reference Number, which you can obtain by calling 132 360. This number serves as proof of immediate notification.
Fill in the 'Person Submitting Details' section with your name, position title, date, and telephone number. Ensure all information is printed clearly.
Provide details about the incident including the date, time, and location where it occurred. Include a brief description of the incident.
Complete the 'Details of Deceased / Injured Person(s)' section if applicable. Include their name, gender, residential address, date of birth, occupation, and a brief description of injuries sustained.
In the 'Action Taken' section, describe any measures taken to prevent recurrence of the incident.
Review your entries for accuracy before signing and dating the declaration at the bottom of the form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I report an incident or accident?

How to Write an Incident Report: A Step-by-Step Guide (with Examples) Step 1: Provide Fundamental Information. Step 2: Take Note of Any Damages and Injuries. Step 3: Identify Affected Individual(s) Step 4: Identify Witnesses and Take Their Statements. Step 5: Take Action. Step 6: Close Your Report.

What needs to be notified in WorkSafe?

A notifiable event is any of the following work-related events: a death a notifiable injury or illness or a notifiable incident. Only serious events are intended to be notified.

How do I report an incident to WorkSafe Victoria?

If youd like to speak to someone right away, WorkSafes advisory service is available between 7:30am and 6:30pm Monday to Friday by calling 1800 136 089. To report an emergency 24 hours a day, 7 days a week, you can call 13 23 60.

What are the procedures for incident reporting?

The procedure typically involves identifying the incident, gathering relevant information, completing an incident report form, notifying the appropriate personnel, and implementing corrective actions.

What are reportable incidents?

Reportable Incidents are specific types of serious incidents that have, or are alleged to have, occurred in connection with the provision of supports and services by registered NDIS providers. These are: The death of a person with disability. Serious injury of a person with disability.

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How do I contact WorkSafe in Victoria?

Contact WorkSafe Victoria report an incident. Instead call WorkSafe Advisory on 1800 136 089 or for 24/7 emergencies call 13 23 60.

How do I fill in an incident report form?

Provide date and time of the incident and when it was first reported, details of witnesses, and a succinct statement describing the events leading to the incident, the details of the incident, the type of work being undertaken, any hazards involved in the work and any personal protective equipment being used.