Injury, Near Miss and Hazard Report Form
v3.0
Purpose. Used by any member to report an injury, illness, exposure, near miss, hazard, vehicle incident or equipment failure so that it is recorded, investigated and acted on.
1.When to use this form
Complete this form for any injury or illness arising from duty, any exposure to smoke, chemicals or biological hazards, any near miss, any hazard found at a station, unit or incident, any appliance or vehicle incident, and any failure of equipment that put a member at risk. The form must be completed within 24 hours by the member involved or the officer in charge.
2.First actions
Treat the injured person, make the scene safe and tell the officer in charge before completing the form. For a serious injury the incident controller must call for ambulance and preserve the scene for investigation. Equipment involved in a failure must be tagged out and kept.
3.Completing the form
Describe what happened in order with times, the incident number if it occurred at an incident, the task being performed, the equipment and protective clothing in use, the conditions, the people involved and any witnesses. Record first aid and medical treatment.
4.What happens next
The officer in charge enters the report in the Health and Safety Incident Register, investigates the causes and records corrective actions. The Manager Training, Safety and Welfare reviews every report and the Chief Officer decides on regulator notification. The member is told the outcome and offered peer support where relevant.
5.Privacy
Medical information on this form is used only for injury management and legal obligations and is stored in the confidential injury file.