Worksafe incident report template 2026

1. Click ‘Get Form’ to open the worksafe incident report template in the editor.
2. Begin by entering the Reference Number. Call 132 360 to obtain this number, which serves as proof of immediate notification.
3. Fill in your personal details in BLOCK letters, including your Name, Position Title, Date, and Telephone Number.
4. Provide the Date and Time of the Incident along with the Name of the Employer or Self-Employed Person responsible at that time.
5. Describe where the incident occurred by filling in the Address or Location and providing a Brief Description of the Incident.
6. Detail any Deceased or Injured Persons involved, including their Name, Gender, Residential Address, Date of Birth, and Occupation/Job Title.
7. Indicate what Work or Activity was being undertaken at the time of the incident and briefly describe any injuries sustained.
8. List any witnesses who saw the incident or were first on scene and outline any Actions Taken to prevent recurrence.
9. Complete the Declaration section if applicable, ensuring you are authorized to provide personal information about others.

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