Incident and Environmental Event Report Form
v2.2
Purpose. Used by any worker to report an injury, near miss, hazard, spill, odour event, fire, complaint or other environmental event on the day it occurs.
1.When to use this form
Complete this form for every injury, illness, near miss, hazard, fire, spill, leachate or stormwater escape, odour or dust event, litter escape, community complaint and any exceedance of a licence limit, however minor. The form must be completed before the end of the shift and given to the supervisor, who must enter it in the incident, hazard and environmental event register.
2.Immediate actions
Make the area safe and stop the source first. For a spill or escape, contain it with the spill kit or bund and prevent it reaching a drain. For a fire, follow the emergency plan and call emergency services if it cannot be controlled immediately. Do not disturb the scene of a serious injury until the Safety and Compliance Manager releases it.
3.Regulatory notification
Pollution incidents that cause or threaten material harm must be reported to the regulator and the other authorities listed in the pollution incident response plan immediately. The Safety and Compliance Manager makes the notification and must be told by the fastest available means.
4.Describing the event
Describe what happened in order, the materials, plant and people involved, the weather and the quantities released or affected. Record facts rather than blame. Attach photographs and any field readings.
5.Follow up
The supervisor will record immediate corrective actions and classify the event. The Safety and Compliance Manager will decide whether a formal investigation is required and will track all actions to closure in the register.