BSBWHS401

Implement and monitor WHS policies,

procedures and programs to meet legislative requirements.

ASSESSMENT TASK 2 – ACTIVITY 1

Hazard Scenario

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
Family name: Thompson First name: Rosie
Contact Phone No: (w)0426160884 (h – if injured)
Occupation: Cooking assistant Gender: x M  F
Staff employment status:

Full-time Part-time Casual

Contractor Visitor

Division/Department:
Incident details

Date of incident:14-02- Time of incident: 10 PM

2019
Location where incident occurred:

The accident was inside the kitchen

Briefly describe what happened:

Peter try to hold a Pizza that was inside the Oven and he burnt his hands

This incident resulted in:

Injury No injury Near miss

Property damage Hazard identified

The incident was reported to (Supervisor):

Name of Supervisor: _Luis Bonilla_______________________ Date: ___15-02-2019

Injury/damage details

If an injury was sustained, what part of the body was affected; or if damage to property
occurred, what was damaged?

He burnt his hands, they are red but is not injury

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

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.

Do you intend to seek medical treatment? Yes No

Do you intend to lodge a claim for workers compensation? Yes No

Has any Time been lost from work? Yes No

Just for 
half an
(More than 1 complete shift) hour Yes No

If so, have you returned to work?

Have medical expenses been incurred/will medical expenses be Yes No

incurred? Uncertain at
this time
Were there witnesses? Witness(es) contact
If so, provide name of witness(es): phone number:

Employee signature: Date:

If a medical certificate has been provided please send to: Fax xxxx xxxx
Describe in detail what occurred
It is the responsibility of the supervisor/line manager to complete this section in consultation
with the injured staff member.

Please describe the events and contributing factors that led to the incident:

Around 10 pm Peter was waiting for a Pasta and a Pizza, the Pizza man was not there in that
moment so he decide to open the oven and take the pizza out, the pizza was very close to the
door so he thought the fastest way will be with his hands in a fast movement, but the pizza was
extremely hot and he had to dropped it. He was very fast so is a minor injury, just red and hurt
just for few minutes.

How could this be prevented from happening again?

The supervisor/line manager is to complete this section in consultation with the injured staff
member and the health and safety representative (if applicable).

Suggestions to avoid recurrence of this incident/accident:

Is important that just training personal can use the gloves

An extra pair of Gloves for the oven , could be helpful

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

Name of health and safety representative, if consulted:

Jose Luis Cubides , that is one of the manager of the restaurant is studying and he would be the new
health and safety representative

Action plan
Note: From the previous section, list the actions required to prevent this happening again.

Action to prevent Person Action Sign-off

recurrence responsible for taken Completed (signature
(Do not leave blank) action required)
Oven Training Pizza man Couse with all
the kitchen staff
Buy an extra pair of
gloves
Put the gloves in a
specific place in
case that someone
else would use the
oven

Placed issue on local action

Referred to line manager plan

Consulted employees Advised senior manager

Advised WHSW Services CSR raised, referred to FMU

Feedback provided to affected person on outcome

Is rehabilitation required? Rehabilitation consultant advised

Yes Date:

No

Name of Supervisor: Contact Phone Number:

Signed: Date:

Analyse data
25/08/2019 Gonzalo Lopez Student ID 1006
 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

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.

Incident Cause Type Who When

Slip/trip Cables on floor MTI Bob 13/07

Muscle pull Lifting paper MTI Jane 18/07

Muscle pull Moving bins FAI Nihal 30/08

Bullying Project deadline LTI Laszlo 15/09

Stress Project deadline LTI Greg 17/09

Slip/trip Cables on floor Bob 01/10

Cut Cut finger on broken glass FAI Rita 02/10

FAI first aid incidents

MTI medical treatment injury

LTI lost time injury

LTIFR lost time injury frequency rate

NM near miss

Graph the data from the table above.

Number of Incidents

incident

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

# Incidents
3.5

2.5

1.5

0.5

0
FAI MTI LTI LTIFR NM

Analyse the data above and suggest what you will need to focus on during the safety
action meeting.

Safety inspection form

Criteria N/A Yes No Comments

EMERGENCY PROCEDURES

Are designated emergency persons’ x Jose Luis Cubides

details posted, including:

● health and safety

representative

● fire warden

● first aid person?

Are instructions posted for calling X Near the phone

emergency services?

The evacuation is for the

Are emergency evacuation x
two doors to the Darlin

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

Harbour not to the

shopping center

muster/assembly areas signposted?

Just the manager that are

Have all staff been inducted and x always there

trained in emergency procedures?

Are entry and exit doors marked and x

free of clutter?

Are emergency exit routes and aisles x

and corridors free of clutter?

Are fire extinguishers provided and x

maintained?

Have personnel onsite been trained in x Manager

the use of fire extinguishers?

Are first aid kit/s stocked to contents x

list?

Are first aid supplies replenished? x

HOUSEKEEPING

Is the bathroom and toilet clean and

tidy? x

Is the kitchen and eating area clean

and tidy? X

Are floors clean, dry and in good

condition? X

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

Criteria N/A Yes No Comments

Always , is avery tidy and

Are desks and work areas tidy? x luxury restaurant

Are rubbish bins sufficient? x

Is rubbish cleared regularly? x

Are recycling bins sufficient? x

Are recycling bins cleared regularly? x

Are aisles and areas around x

workstations free of clutter?

ERGONOMICS

Is furniture fit for purpose? x

Do office chairs have five supports? x

Is furniture adjustable for keyboard x

operators?

● straight back

● forearms parallel to the floor

● upper legs parallel to the floor

Are footrests provided where x

necessary?

Are document supports provided?

Are computer screens positioned to x

avoid glare?

Are workstations and equipment x

positioned to:

● reduce manual handling

● reduce repetitive handling

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

● improve work flow?

HAZARDOUS SUBSTANCES

Are all chemicals, including liquid x

fuels, properly labelled, stored and

signposted?

Are spill kits available? X

Are MSDS readily available for X

hazardous substances?

Criteria N/A Yes No Comments

Is a hazardous materials register x Yes every day
maintained?

PPE (for hazardous areas)

Is safety signage accurate? x

Is safety signage displayed x

correctly?

Is safety signage displayed x

correctly?

Are safety glasses worn x

when required?

Is high-visibility clothing x
provided where required?

OTHER

PERSONAL PROTECTIVE EQUIPMENT

Is important to organize an space close to the oven where everybody can use the following :

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

Safety glasses must be Long and loose hair Gloves must be worn.
worn at all times in work must be contained.
areas.

Sturdy footwear must be Close fitting/protective Rings and jewellery

worn at all times in work clothing must be worn. must not be worn.
areas.

PRE-OPERATIONAL SAFETY CHECKS

 Locate and ensure you are familiar with all machine operations and controls.
 Check workspaces and walkways to ensure no slip/trip hazards are present.
OPERATIONAL SAFETY CHECKS
 Pre-heat the oven for at least five minutes to be sure the oven compartment has reached the required
temperature.

 Be aware of other people in the area when handling hot material.

 Use thermal gloves or tongs to remove workpiece from the oven.
 Ovens must be located with due regard to the possibility of fire resulting from overheating.
ENDING OPERATIONS AND CLEANING UP
 Switch off the oven when work completed.
 Before cleaning material accumulations, switch off and allow the oven to completely cool.
 Leave the oven and work area in a safe, clean and tidy state.
POTENTIAL HAZARDS AND INJURIES
 Burns from hot surfaces.
 Fumes.
 Sources of ignition from hot surfaces and workpiece.
DON’T
 Do not use faulty equipment. Immediately report suspect machinery.

 Do not use any ovens used for workshop applications for food preparation.

 Do not heat a sealed container.

 Do not heat any flammable or combustible liquid in the oven. A fire and/or explosion may result.

 Do not heat any material that might pose a hazard because of acute or chronic toxicity, unless special
precautions have been taken to ensure continuous venting of the atmosphere inside the oven.

 Do not overheat the workpiece

25/08/2019 Gonzalo Lopez Student ID 1006

 BSBWHS401
Implement and monitor WHS policies,
procedures and programs to meet legislative requirements.

SAM record form

Work safety team: ..................................................................................................................

Meeting held on: ....................................................................................................................

Meeting conducted by (supervisor): ......................................................................................

HSR in attendance: Yes / No

OVEN USE PIZZERIA

PRE-OPERATIONAL SAFETY CHECKS
 Locate and ensure you are familiar with all machine operations and controls.
 Check workspaces and walkways to ensure no slip/trip hazards are present.
PERSONAL PROTECTIVE EQUIPMENT
Is important to organize an space close to the oven where everybody can se the following :

Safety glasses must be Long and loose hair must Gloves must be worn.
worn at all times in work be contained.
areas.

Sturdy footwear must be Close fitting/protective Rings and jewellery must

worn at all times in work clothing must be worn. not be worn.
areas.

OPERATIONAL SAFETY CHECKS

 Pre-heat the oven for at least five minutes to be sure the oven compartment has reached the required
temperature.

 Be aware of other people in the area when handling hot material.

 Use thermal gloves or tongs to remove workpiece from the oven.
 Ovens must be located with due regard to the possibility of fire resulting from overheating.
ENDING OPERATIONS AND CLEANING UP
 Switch off the oven when work completed.
 Before cleaning material accumulations, switch off and allow the oven to completely cool.
 Leave the oven and work area in a safe, clean and tidy state.
POTENTIAL HAZARDS AND INJURIES
 Burns from hot surfaces.
 Fumes.
 Sources of ignition from hot surfaces and workpiece.
DON’T
 Do not use faulty equipment. Immediately report suspect machinery.

 Do not use any ovens used for workshop applications for food preparation.

 Do not heat a sealed container.

 Do not heat any flammable or combustible liquid in the oven. A fire and/or explosion may result.

25/08/2019 Gonzalo Lopez Student ID 1006

25/08/2019 Gonzalo Lopez Student ID 1006