BSBWHS416 – CONTRIBUTE TO WORKPLACE INCIDENT RESPONSE

PROJECT ASSESSMENT
1

WHS Bill 2019

Section 19 Notification of Notifiable Incident
On the 13th of January 2020 at the Perth Steel fabrication an incident occurred that saw one
employee injured.

The incident was reported as a result of incomplete PPE, lack of MSDS knowledge and an
unregistered inductee. Meaning he was never undergone workplace induction prior to starting
work with company.

Currently, the injured person has been taken to the hospital by an ambulance after undergoing
first aid treatment.

2 Incident Report Form

Class of Incident Reported

 Injury  Property/Plant Damage Yes  No  Details:
 Near Miss  Environmental Further Action Required
 Other…………………….  Report to Authorities  Other:

Details of Incident

Date of Incident 13th January 2020 Time of Incident 2 am  pm 

Witness Name
Nature of Incident
Location of Incident
Description of Incident
Details of damage to
equipment/property?
Raymond Witness Contact 0478 786 009
Damage to eyesight
Perth Steel Fabrication work site
Eye contact with toxic fumes
No damage to equipment/property

Injured Person/s (if applicable)

Name Mick
Address Kent Street, Rockingham, WA 6168
Date of Birth 15th January 1998
Occupation Trades Assistant Employer Perth Steel Fabrication
Referred/transferred to

Recommended Preventive Action

Details WHS Training

Completed By
Name Chong Position Safety Officer
Signature Chong Date 14th January 2020
 3.Incident Investigation Plan

Steps Procedure Person Responsible

1 Immediate Action Works Managers, Works

Supervisor and workers

2 Investigation Preparation OSHE Committee

3 Collecting Data OSHE Representatives, OSHE

Coordinators, Supervisors

4 Analysing Data OSHE Committee

5 Corrective Action OSHE Committee

6 Report Results Management