Documente Academic
Documente Profesional
Documente Cultură
Incident report
Note: All sections of this form are to be completed. All incidents shall be advised within 12 hours of the incident
to ensure appropriate action is initiated.
Personal details
Contractor Visitor
Division/Department: Administration
Incident details
Date of incident:29/03/2017 Time of incident: 3.40pm PM
Briefly describe what happened: Rosie tripped on one of the computer cables fell on the floor and sprained
her wrist.
This incident resulted in:
Injury/damage details
If an injury was sustained, what part of the body was affected; or if damage to property occurred, what was
damaged?
Medical treatment
If MEDICAL EXPENSES or LOST TIME is incurred, a Workers Compensation Claim form must be completed
and forwarded to WHSW & IM Services as soon as possible.
If a medical certificate has been provided please send to: Fax 026307251 or email: jw@admin office .com.au
Please describe the events and contributing factors that led to the incident:
Rapid growth in the company led to many new computers being installed and the power extension cables
became loose and were lying on the floor of the hallway and office. There have been a number of near misses
(near accidents) with many employees.
Install many new power points in close proximity to the computers to avoid any loose cables.
Install multiple power points Electrician New Power points Gary Bender
and wiring
installed
Yes Date:29/03/2017
No
The workplace incident data for the past three months is recorded in the incident register below. Summarise
the data in the graph provided and identify the areas that you should concentrate your improvement efforts on.
NM near miss
workplace data
2.5
1.5
Number
of
Incidents 1
0.5
0
MTI LTI FAI NMI LTIFR
Incident
INCIDENTS
Analyse the data above and suggest what you will need to focus on during the safety action meeting.
Based On the data above there was one near miss for a fall for an employee, however there were two falls
that resulted in first aid treatment and two due to lost time .
Safety action required is training on how to lift properly to prevent pulled muscles by Jane and Nihal. Trolleys
to move bins may also be required or bins on wheels.
Removal of cables with added power points to prevent fall , near misses by Bob.
Both of the actions above require re- engineering of the premises and retraining of employees which an
administrative control
Lastly two employees Laszlo and Greg had time off work due to stress/ bullying as a result of meeting tight
deadlines.
There are two solutions employ more staff to complete the work or extend the deadlines to reduce the stress.
Both of these are classified as administrative controls
Are instructions posted for calling emergency services? Yes Corridor Wall
Are emergency evacuation muster/assembly areas Yes Yes opposite 118 Walker st
signposted?
Have all staff been inducted and trained in emergency Yes Induction
procedures?
Are entry and exit doors marked and free of clutter? Yes All elevators freely available
Are emergency exit routes and aisles and corridors free Yes No Blockage to stairwells
of clutter?
Have personnel onsite been trained in the use of fire Yes Firewarden on floor trained
extinguishers?
Are first aid kit/s stocked to contents list? Yes First Aid room
HOUSEKEEPING
Is the bathroom and toilet clean and tidy? Yes No paper on the floor
Is the kitchen and eating area clean and tidy? Yes No water on the floor
Are floors clean, dry and in good condition? Yes All carpet is smooth no tears
Are desks and work areas tidy? Yes Computers are removed daily
Are recycling bins cleared regularly? Yes Separate work station room
Are aisles and areas around workstations free of clutter? Yes Yes all materials in cupboards
Criteria N/A Yes No Comments
ERGONOMICS
Is furniture fit for purpose? Yes Office furniture new
Are workstations and equipment positioned to: Yes reduce manual handling
reduce repetitive handling
● reduce manual handling
improve work flow?
● reduce repetitive handling
● improve work flow?
HAZARDOUS SUBSTANCES
Are all chemicals, including liquid fuels, properly NA Not relevant to office workplace
labelled, stored and signposted?
Are MSDS readily available for hazardous substances? NA Not relevant to office workplace
Are safety glasses worn when required? NA Not relevant to office workplace
OTHER
Appendix 5: SAM record form
At about 3:40pm, D'Alessandro was in charge of two workers in the pit and to manually assist the correct
positioning of the fourth wall as it was lowered into position.
The only means of entrance and egress was a steel ladder to the top of one of the walls (panel 2).
The pit was only slightly larger than the box made by the walls and the workers had no means of escape other
than the ladder.
Panel 2 began to fall forward and the two workers managed to scale the ladder on that wall and ride down and
jumped onto its back as it fell.
The failure of this wall caused another wall (panel 1) to immediately fall forward as it was no longer supported.
The two workers were unable to escape the second wall falling and were crushed to death in between the two
panels.
....................................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
WHS Officer
Outcomes: ..................................................................................................................................................
....................................................................................................................................................................
....................................................................................................................................................................
Attendees: