Incident report

1. DETAILS OF PERSON MAKING REPORT

Name: Kevin
Position: Management
Job Title: Operation General Manager
2. DETAILS OF INCIDENT
Date: 28/6/2021
Time: 1pm
Location: 10th floor emergency exit
Describe what happened and how: A client felt from staircase and breaking her wrist while she was
rushed for leaving the company
SUGGEST CORRECTIVE ACTIONS
3. DETAILS OF WITNESSES
Name: Tommy Hill
Job title: Operation Security
Name: Fred Jon
Job title: Operation Security
Sign:Hill.Tommy
Date: 29/6/2021
Sign: Jon.Fred
Date: 29/6/2021

Injury report

Status : Employee Contractor

Other Outcome: Near miss Injury
1. Details of Injured Persons
Name: Catherine Larry
Phone: 0456789032 (W)
Address: 7/15 Spencer Street, Sydney, nsw, 2000
Sex: F
Date of birth: 09/08/1990
Job Title: N/A Start time: 1 pm
Work Arrangement: Casual Full-Time Part time Other
2. Detail of the incident
Date: 28/6/2021
Time: 1pm
Location: 10th floor Emergency Exit
Describe what happen and how: A client felt from staircase and breaking her wrist while she was
rushed for leaving the company
3. Details of Witnesses
Name: Jon Fred
Phone: 0410240900 (W)
Address: 204/19 King Street, sydney, nsw 2000
4. Details of injury
Nature of injury : Poured oil substance on staircase
Cause of injury : Felt from staircase because of the slippery
Location on body : Wrist
5. Treatment Administered
First aid given: Yes No
First aider name: Tommy Hill Treatment
Referred to : N/A
*Section 6-9 must be completed by employer
6. Did the injured person stop work ?
Yes No If yes,state date:N/A Time:N/A
Outcome:
Treated by doctor
Hospitalised
Returned to normal work
Alternative duties
Workers compensation
claim Rehabilitation
7.Incident Investigation (comments to include causal factors): The operation manager will taking
action for investigate these WHS incident and act proactively to reduce risk
8. Risk Assessment
Likelihood of recurrence: May happen again if the management never taking any action for solving
these WHS risk Severity of outcome: 3 Level of risk: High
9.Action to prevent recurrence:
Action By whom By when Date completed
consult with agents on Operation manager 1/7/2021 8/7/2021
WHS issues to
continually identify any
potential risks
regularly conduct WHS Operation manager 4/7/2021 14/7/2021
committee meetings to
address risk across the
Organisation
regularly assess Operation manager 5/7/2021 20/7/2021
potential workplace
hazards
act proactively to Operation manager 9/7/2021 22/7/2021
reduce risk
update the risk register Operation manager 13/7/2021 24/7/2021
10.Action completed All assigned plan is on the progress of proceeding
Signed (Manager) : Kevin
Title: Operation Manager
Date: 30/6/2021
Feedback to person involved: Mr.Gerrad Vin (Human Resource Manager)
Date: 30/6/2021
11. Review comments
WHS committee/staff meeting :
1. Gerrad Vin (Human Resource Manager)
2. Eva Kong (Operation Assistant Manager )
3. Wendy Su (WHS Committee Representative)
Reviewed by site manager
(signed): Vin.Gerrad Date:10/7/2021 Reviewed by Health & Safe Rep.
(signed): Su.Wendy Date: 10/7/2021
Risk assessment form

Details
Name: Kevin
Position: Operation Manager
Risk details
Risk ID: A0001
Raised by: Fred Jon
Date raised: 28/6/2021
Description of the risk: Safety hazard - Injury on any of body part that may cause victim become
disable or broken of bone cause by failing
Likelihood of the risk: Medium Impact of the risk: broken of bone on any of
body part
Preventative actions recommended: undertake risk assessments and implement procedures to
adequately manage any
 risks in the working environment provide written procedures and instructions for safe
working practices
 ensure compliance with all relevant legislation
 maintain safe systems of work including the work premises and environment
 provide appropriate support, instruction, training and supervision to employees to
 ensure safe working practices.
Contingency actions recommended: the effective implementation and regular review of WHS
procedures
 consultation with employees regarding health and safety issues and changes to
 legislation and/or working practices which may affect the health, safety or welfare of
employee providing and maintaining a safe system of working practices
 providing support, training, and supervision to employees to ensure safe and
 healthy workplace practices are carried out, including relevant first aid training where
appropriate The provision of adequate resources for employees to meet the WHS
 commitment, including an up-todate first aid kit.
Approved details 10/2021 – AdityaDutta, CFO
Supporting documentation:
 Privacy Act 1998
 Estate Agents Act 1980
 Equal Opportunity Act 2010 (Vic)
 Occupational Health and Safety Act 2004
 Dangerous Goods Act 1985
 AS/NZS 4804:2001 Occupational health and safety management systems – General
guidelines on principles, systems and supporting techniques
Signature : Kevin
Date: 5/7/2021

Risk register

Risk Likelihood Impact (H/M/L) Risk response Responsible

(H/M/L) (Contingency
strategies)
Safety hazard M H  Eliminatio n - Operation
Sometime s Manager
hazards –
 equipment
substances or
work practices
- can be
avoided
entirely.
Isolation –
 Separate the
hazard from
people, by
marking the
hazardous
area, fitting
screens or
putting up
safety barriers
Chemical hazard H H  Instructing Operation
workers in the Manager
safest way to
do something -
This means
developin g
and enforcing
safe work
procedures .
Students on
workexperienc
e must be
given
informatio n
and instruction
and must
follow agreed
procedures to
ensure their
safety.
 Elimination -
Sometime s
hazards -
equipment ,
substances or
work practices
- can be
avoided
entirely.