Incident and Hazard Report Form
v2.4
Purpose. Used by any staff member to report an injury, near miss, hazard, security incident, privacy breach or property damage on any site within the shift or working day.
1.When to use this form
Complete this form for every injury, illness, near miss, hazard, threat, assault, trespass, theft, alarm activation requiring response, use of force, privacy breach, chemical spill or property damage. If in doubt, report it.
2.How to complete it
Write what you saw and did in time order using plain language. Record the names and contact details of people involved and witnesses. Record what you said and what was said to you as closely as you can. Do not record opinions about cause or blame. Note any police event number and any CCTV that must be retained.
3.Serious incidents
For any assault, use of force, injury needing medical treatment or police attendance, phone the control room or your manager immediately and complete the form before the end of the shift.
4.What happens next
Your manager will review the report, enter or confirm it in the incident register, decide whether an investigation or a client report is needed and tell you the outcome.
5.Privacy
Personal information on this form is used only to manage the incident and any claim. Health information is stored separately from personnel records.