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NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA

NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA 2025

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The document is a Notifiable Incident Report Form from SafeWork SA, designed for reporting serious injuries, illnesses, and dangerous incidents under the Work Health and Safety Act 2012. It outlines the responsibilities of the Person Conducting a Business or Undertaking (PCBU) to report such incidents, provides detailed instructions for completing the form, and defines what constitutes a notifiable incident, serious injury or illness, and dangerous incident. The form must be submitted promptly via fax or email, with specific details required about the incident and involved parties.

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What type of incidents are mentioned as notifiable?

Specified, reportable injuries to workers amputation of an arm, hand, finger, thumb, leg, foot or toe. any injury likely to cause permanent blinding or reduction in sight in one or both eyes. any crush injury to the head or torso causing damage to the brain or internal organs in the chest or abdomen.

What must be recorded on an incident report form?

If you do not keep a copy of the online form your records must include the date and method of reporting; the date, time and place of the event; personal details of those involved; and a brief description of the nature of the event or disease.

What are examples of reportable incidents?

Reportable incidents unreasonable use of force. unlawful sexual contact or inappropriate sexual conduct. psychological or emotional abuse. unexpected death. stealing or financial coercion by a staff member. neglect. inappropriate use of restrictive practices. unexplained absence.

What is an example of a notifiable event?

A notifiable incident is where someones health or safety is seriously endangered or threatened. People may be put at serious risk even if they were some distance from the incident, for example, from a gas leak.

What is an example of a notifiable incident?

A notifiable incident is: the death of a person. a serious injury or illness, or. a dangerous incident that exposes someone to a serious risk (even if no one is injured)

What form must be used for reporting incidents?

Complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If youre not sure whether a case is recordable, call your local OSHA office for help.

What are notifiable incidents examples?

Notifiable incidents the death of a person. a serious injury or illness, or. a dangerous incident that exposes someone to a serious risk (even if no one is injured)

What is a notifiable incident that is required to be reported to Safework SA?

Notification requirement A person conducting a business or undertaking (PCBU) must notify us of fatalities and certain serious injuries/illnesses, dangerous incidents or COVID-19 cases that occur at work as a result of the conduct of the business or undertaking.

NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA 2025

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What type of incidents are mentioned as notifiable?

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What is an example of a notifiable incident?

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What form must be used for reporting incidents?

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NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA 2025

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The fastest way to redact NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA online

See more NOTIFIABLE INCIDENT REPORT FORM - SafeWork SA - SA versions

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Got questions?

What type of incidents are mentioned as notifiable?

What must be recorded on an incident report form?

What are examples of reportable incidents?

What is an example of a notifiable event?

What is an example of a notifiable incident?

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What form must be used for reporting incidents?

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What is a notifiable incident that is required to be reported to Safework SA?

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