Marca lateral
INCIDENT & ACCIDENT INVESTIGATION REPORT Doc Ref: QS {{ str_pad($incident->id, 4, '0', STR_PAD_LEFT) }}
This report needs to be completed as soon as reasonably practicable after an incident/accident and submitted to Management for assessment with any related documentation. OH&S Manager & GM to be notified asap, within 24 hours according to severity.
INCIDENT DETAILS
Investigation Team Client
Responsible		 {{$incident->company->name}} Manager on duty {{$incident->manager_on_duty}}
Date of Incident {{$incident->incident_date}} Date of Investigation {{$incident->incident_date}}
Location {{$incident->project->address}} Job Number {{$incident->project->name}}
Site Contact Name {{$incident->site_contact_name}} Site Contact Number {{$incident->project->site_contact_number}}
INVESTIGATION DETAILS
Persons involved in the incident {{$incident->persons_involved_incident}}
Describe the sequence of events of the incident {{$incident->description_sequence_events}}
Immediate action taken as a result of the incident {{$incident->immediate_action_taken}}
DID ANY OF THESE FACTORS CONTRIBUTE TO THE INCIDENT/HAZARD/ACCIDENT? IDENTIFY THE CAUSE OF ISSUE
People - Performance
Check Box Lack of training Check Box Lack of competence Check Box Lack of Supervision Check Box Lack of instruction
Check Box PPE not used Check Box Failure to observe Safe Work Practices Check Box Other: Ground Checks/Netting
Plant & Equipment
Check Box Failure Check Box Size/Weight Check Box Insufficient Maintenance Check Box Design Check Box Other:
Incident Classification
Check Box Death Check Box Personal Injury Check Box Equipment damage Estimated Cost: {{$incident->estimated_cost}}
Check Box Theft Check Box Near Miss Check Box Property damage
Check Box Not Applicable
Check Box Other:
Personal injury (If Yes please fill this part)
Body Part: {{$incident->body_part}}
Check Box Right Side Check Box Left Side
Was the injury reported to the worker’s supervisor? {{$incident->injury_reported_to_supervisor}} Was any treatment provided/ First Aid? {{$incident->treatment_provided_first_aid}}
Was the injury reported take it to the Hospital? {{$incident->injury_reported_to_hospital}} Who was the person taking the injured person to the hospital? {{$incident->person_taking_injured_to_hospital}}
RECOMMENDATION (COMPLETE WITH CLIENT IF REQUIRED)
Investigation recommendations for controls to prevent a similar incident occurring {{$incident->investigation_recommendations}}
NOTIFICATION
Advised Client Check Box YES {{$incident->advised_client_reason}}
{{ \Carbon\Carbon::parse($incident->advised_client_date)->format('h:i A') }}
{{ \Carbon\Carbon::parse($incident->advised_client_date)->format('d/m/Y') }}
Advised Orgen Management (within 24hrs) Check Box YES {{$incident->advised_orgen_management_reason}}
{{ \Carbon\Carbon::parse($incident->advised_orgen_management_date)->format('h:i A') }}
{{ \Carbon\Carbon::parse($incident->advised_orgen_management_date)->format('d/m/Y') }}
Reportable to WorkSafe? Check with OH&S Manager Check Box YES {{$incident->reportable_to_worksafe_reason}}
"{{ \Carbon\Carbon::parse($incident->reportable_to_worksafe_date)->format('h:i A') }}"
"{{ \Carbon\Carbon::parse($incident->reportable_to_worksafe_date)->format('d/m/Y') }}"
SIGN OFF Print Name Signature
Person/s injured or responsible {{$incident->person_injured_or_responsible}} @if(!empty($incident->person_injured_or_responsible_path_signature) && file_exists(public_path($incident->person_injured_or_responsible_path_signature))) Signature @endif {{ \Carbon\Carbon::parse($incident->person_injured_or_responsible_date)->format('d/m/Y h:i A') }}
Client Responsible {{$incident->client_responsible}} @if(!empty($incident->client_responsible_path_signature) && file_exists(public_path($incident->client_responsible_path_signature))) Signature @endif {{ \Carbon\Carbon::parse($incident->client_responsible_date)->format('d/m/Y h:i A') }}
OHS Manager/Director {{$incident->ohs_manager_or_director}} @if(!empty($incident->ohs_manager_or_director_path_signature) && file_exists(public_path($incident->ohs_manager_or_director_path_signature))) Signature @endif {{ \Carbon\Carbon::parse($incident->ohs_manager_or_director_date)->format('d/m/Y h:i A') }}
Requirements of injury notification
  • An injured worker (or someone acting on their behalf) must notify the employer in writing of any work-related injury or illness within 30 days of becoming aware of the injury or illness.
  • Employers must provide written confirmation to the injured worker that they received notification of the injury or illness.
  • Employers should provide a signed and dated copy of this entry to the injured worker.
  • To make a WorkSafe claim the injured worker must complete a Worker’s Injury Claim Form, available from the Australia Post.
@if($incident->evidence_paths && count($incident->evidence_paths) > 0)
Evidences.
@foreach($incident->evidence_paths as $path) @endforeach
Photo
@endif