Page 32 - GTE Operations Manual

HEALTH & SAFETY
WORK PLACE INJURY REPORTING FORM
Employee's Report of Injury Form
Employee's shall use this form for reporting all work related injuries or 'near miss' events. This helps us to identify and correct any hazards or working practices before they cause serious harm. This form shall be filled in as soon as practically possible after the event.
I am reporting a work related:
Your name:
Date of injury:
Where, exactly did it happen?
What were you doing at the time?
Describe step by step what lead to the injury or near miss:
Continue on back if required. It is very important you give us as much information as you can
What could have been done to prevent this incident?
Include anything management/ main contractor could have done to prevent or minimize incident
What parts of your body have been hurt/ would have been hurt?
Near miss
Injury
Time of injury:
Thank you for your cooperation. Completing this form leads to a safer environment for all team members and the public. If you need assistance with filling ACC paperwork or the like, please contact the office.
32 OPERATIONS MANUAL 2021