Incident and Hazard Report Form
v3.0
Purpose. Workers use this form to report any incident, near miss, hazard, injury, allegation or behaviour of concern within 24 hours of it occurring.
1.When to use this form
Complete this form for any event that caused or nearly caused harm to a client, worker, volunteer or visitor, any hazard you notice, any allegation of abuse or neglect, any medication error, any use of a restrictive practice and any vehicle incident. Complete it within 24 hours even if you have already phoned your coordinator.
2.How to describe the incident
Write what you saw and heard in plain words and in order. Record the words the person used where you can. Do not write opinions about fault or whether an allegation is true. State who was present, what you did and who you told.
3.What happens next
Your coordinator will review the form within one working day and decide with the Quality and Safeguarding Manager whether the incident is reportable to a regulator. You will be told the outcome and will be asked for more detail where needed. Every form is entered in the Incident and Hazard Register.
4.Confidentiality
This form contains personal information and must be submitted through the incident register or handed to your coordinator in a sealed envelope. Do not keep copies, photograph the form or discuss the incident with anyone who does not need to know.
5.Support for you
If the incident has affected you, tell your coordinator. Debriefing and the employee assistance program are available to every worker and volunteer.