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Accident Reporting

Accident Reporting

Focus360 gives your employees the ability to record and report incidents, accidents, injuries, near misses and hazards anytime, anywhere that they have internet access.

Details are recorded and distributed in real-time creating awareness throughout the organisation.

Documents and photographs can be uploaded and stored on Focus360

Incident investigation can be perform quickly and easily and corrective actions are monitored and reviewed.

You can assign and track corrective actions to ensure they are implemented and completed.

Escalating email notifications ensure tasks are completed on time.

Track and report safety meeting data, attendance and compliance with company policies.

Comprehensive  reporting functions allow you to track safety performance over a wide range of lead and lag indicators.

Frequency rates and hours worked can be entered, calculated and monitored in real time.

   

Incident Report Form

Workplace Details
Report Date: Open Calendar-:
Name of Workplace:
Department/Location:
Street Address:
Country:
State:
City/Suburb:
Postcode:
Person(s) involved and witness(es)
1st Person
Name
Connection with workplace
If other, please specify:
Involvement in incident
If other, please specify:
Telephone
Attach written statement
Upload a new file
2nd Person
Name
Connection with workplace
If other, please specify:
Involvement in incident
If other, please specify:
Telephone
Attach written statement
Upload a new file
3rd Person
Name
Connection with workplace
If other, please specify:
Involvement in incident
If other, please specify:
Telephone
Attach written statement
Upload a new file
Incident Details
Date/Time of Incident: Open Calendar-:
Fire:
Tick if applicable
Assault:
Tick if applicable
Armed Robbery:
Tick if applicable
Personal Injury:
Tick if applicable
Property Damage:
Tick if applicable
Describe what happened:
Describe the resulting injury (if any):
Body Part Injured:
If more than one body part injured, select part with most severe injury sustained and include other injuries in the free field above 'Describe the resulting injury'.
What type of injury:
Possible causes/reasons for incident:
Corrective / Preventative Action
1st Task
Brief summary of task/action required:
I.e. What are you going to do to resolve this issue and what measures will you put in place to ensure it doesn't happen in the future. (E.g. We need to give the employee first aid and/or we must put anti-slip surfaces on the floors). How do we use the most effective method of Risk Control?
Detailed Description:
Person Responsible  
Name:
E-mail Address:
Due Date: Open Calendar
View the Hazard/Risk assessment matrix to determine the urgency of this task and when it should be completed.
2nd Task
Brief summary of task/action required:
I.e. What are you going to do to resolve this issue and what measures will you put in place to ensure it doesn't happen in the future. (E.g. We need to give the employee first aid and/or we must put anti-slip surfaces on the floors). How do we use the most effective method of Risk Control?
Detailed Description:
Person Responsible  
Name:
E-mail Address:
Due Date: Open Calendar
View the Hazard/Risk assessment matrix to determine the urgency of this task and when it should be completed.
3rd Task
Brief summary of task/action required:
I.e. What are you going to do to resolve this issue and what measures will you put in place to ensure it doesn't happen in the future. (E.g. We need to give the employee first aid and/or we must put anti-slip surfaces on the floors). How do we use the most effective method of Risk Control?
Detailed Description:
Person Responsible  
Name:
E-mail Address:
Due Date: Open Calendar
View the Hazard/Risk assessment matrix to determine the urgency of this task and when it should be completed.
Notification
Manager
Contact Required:
Tick if applicable
Contact Method:
Due Date Open Calendar
Return-to-work coordinator
Contact Required:
Tick if applicable
Contact Method:
Due Date Open Calendar
Head Office
Contact Required:
Tick if applicable
Contact Method:
Due Date Open Calendar
Insurer
Contact Required:
Tick if applicable
Contact Method:
Due Date Open Calendar
Work Cover
Contact Required:
Tick if applicable
Contact Method:
Due Date Open Calendar
Other Party
Contact Name:
Contact Method:
Due Date Open Calendar
Make an Insurance Claim (choose an option to continue)
Make a claim/report a lost time injury:
Employer's Details
ABN:*
Insurance Policy Number:
Cost Centre (if known):
Company Name:
Street Address:
State:
Suburb:*
Post Code:*
Company Phone:*
Company Contact Person:*
Contact Phone (If different to above):
Contact Email:*
Reimbursement Schedule:
Attach File:
Upload a new file
Nominated Rehabilitation Provider:
Estimated cost of claim: $
Injured Worker Details
Family Name:*
Given Name:*
Date of Birth:* Open Calendar
Gender:*
E-mail Address:
Street Address:
State:*
Suburb:*
Post Code:*
Home Phone:*
Mobile Phone:
Employment Details
Occupation:*
Employment Type:*
Average hours per week:*
Weekly Award Rate or EBA (Enterprise Bargaining Agreement): $
Average Weekly Earnings/week: $
Location of Incident:
What is the current capacity of the injured party to work?:*
Is the injured person going to miss one or more days of work?:
Has a medical certificate been issued:
Doctor's Details
Treating doctor or Hospital Name:*
Phone Number:
Notifier's Details
Name of Person Completing this Report:*
Relationship to Workplace:*
E-mail Address:*
Street Address:*
Daytime Phone:
Incident Related Actions
Has a Return to Work/Injury Management Plan been developed for the injured worker?:
Attach File:
Upload a new file
Has a Written Offer of Suitable duties been sent to the injured worker?:
Read information about: What are suitable duties?.
Attach File:
Upload a new file
Additional Information that may assist with assessing the claim:
i.e. Medical Costs, Aids such as walking aids
Has the injured party returned to pre-injury duties?:
If No, specify any current actions required:
Further Action Required
Have all actions required been completed?:
If yes, by whom?:
Date Completed: Open Calendar
What is the current capacity of the injured party to work?:
Date Returned to work:
If applicable
Open Calendar
Email Claim to Insurer
Is this Incident Report complete and requires no further action?:
Would you like to e-mail this claim to your Insurer now?:
Insurer's Email Address: