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Free accident incident report form template nz

Nz accident form template 2025

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The document is an Incident and Accident Reporting Form designed for prompt completion following any unplanned event that results in or has the potential for injury, ill-health, damage, or loss. It outlines the reporting process, including necessary details about the incident, the injured party, and investigation procedures. The form emphasizes the importance of notifying the Health, Safety and Wellbeing Service for serious incidents and includes sections for documenting harm and conducting investigations to prevent future occurrences.

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Click ‘Get Form’ to open the nz accident form template in the editor.
Begin by filling in the Vault Reference Number, which should be completed by the Line Manager if the injured person is unable to do so.
In Section 1, provide details about the Faculty or Service Division involved, along with your name and contact information. Specify where and when the incident occurred, including building location, date, time, and any contributing factors.
Describe the incident thoroughly in the provided space. If more room is needed, attach additional sheets or documents.
If there was harm caused, proceed to Section 2. Fill in details about the injured person, including their role and treatment received.
Complete Section 3 for investigation purposes if necessary. Analyze root causes and suggest preventive measures.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (34 Votes)
2017	4.4 Satisfied (161 Votes)

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