This document is Incident Report Form.

It is part of the supporting assessment resources for Assessment Task 2 of SITXWHS005

Incident Report Form

This form is to be completed in the event of an incident or emergency.

Details of incident

Date: 5/ 6 /2023 Time: 12.30 Location: Hotel Kitchen

Name of person/s
involved in incident:

Location of incident: Hotel Kitchen

Provide details of the incident.

During lunch service in the hotel kitchen, Mken Saobar and Ke were involved in an incident. Mken
Saobar accidentally spilled hot oil from a frying pan onto Ke's hand. Ke immediately experienced
pain and sustained burns on their right hand.

Describe any injuries.

Ke sustained burns on their right hand due to contact with hot oil.

Outline actions taken as applicable.

Mken Saobar and Ke were immediately moved to a nearby sink to rinse the affected area with cold water for
approximately 10 minutes to minimize the severity of the burns.
The hotel's first aid kit was accessed, and Ke's burns were covered with a sterile, non-adhesive dressing to
protect the affected area.
The hotel manager was notified of the incident, and the hotel's safety officer arrived promptly to assess the
situation.
Ke was advised to seek medical attention outside the premises for further evaluation and treatment.
Mken Saobar was given a brief reminder about safe handling procedures for hot oil and provided additional
training on kitchen safety protocols.

Describe hazards that may have contributed to or caused the injury.

Insufficient training or familiarity with proper handling techniques for hot oil.
Potential lack of proper personal protective equipment (PPE), such as heat-resistant gloves.
Possible overcrowding or limited workspace in the kitchen, increasing the risk of accidents.

© Pakenham Institute Pty Ltd |RTO No. 41536 l CRICOS Code: 03941H I Website: www.pakenham.edu.au
Unit 2, 66 – 68, Main Street Pakenham VIC 3810 Australia |Phone: 0432 197 654 |Email: admission@pakenham.edu.au
Student Resources for SITXWHS005 | v1.1 | Last reviewed: October 2021 | Not controlled when printed Page1 of 2
This document is Incident Report Form.
It is part of the supporting assessment resources for Assessment Task 2 of SITXWHS005

Other notes and comments

The hotel management will conduct a thorough investigation to identify any underlying causes and take
corrective actions to prevent similar incidents in the future.
A reminder will be sent to all kitchen staff to reinforce safety protocols and emphasize the importance of
regular training and communication regarding potential hazards.

Signature of person completing

report

Print name: Date: 5/6 /2023

© Pakenham Institute Pty Ltd |RTO No. 41536 l CRICOS Code: 03941H I Website: www.pakenham.edu.au
Unit 2, 66 – 68, Main Street Pakenham VIC 3810 Australia |Phone: 0432 197 654 |Email: admission@pakenham.edu.au
Student Resources for SITXWHS005 | v1.1 | Last reviewed: October 2021 | Not controlled when printed Page2 of 2