HAZARD/INCIDENT REPORT FORM USER GUIDE
Contents
1. 11 6 4 Biz geeisKou lacte I RU Tr 12 6 5 Specific task being performed at time of Incident Injury esses 12 6 6 Description of Treatment Provided ccccccccccssseccceeeeeecceececceeseeecsaseeeseseecseageeessaaseesseuseeessaseesssaeees 13 6 7 NaS OFAN duci c M 13 6 8 Name of Treatment Provider cccccccccsscccceeceeceececseseecseececeaeeeseueesseucesseueeseaeeessaeeeseeessaeeessueeesseeeesaaees 13 E Sede 26a ee ee en ee ee eee a ee ee eee eee ee eee 14 7 1 Possible Contributing Factors NRI TTE 14 7 2 Cause ol Hazard CHO PME 15 7 3 PRIS IPAS SES SI MC BINNEN EIER 15 7 4 CONE CLIVE ACU OINS PERPE RRCCE Me 17 8 SU bmitting the FORAY CR E 19 Q Supervisor Notification cccccccsssscccccceseeeceeceeeseeeecseeeeceeeeeeeeeceeeseeegeceeeeseaseceeeeseaseceeeseaaeeeeesessaeeeesssaeeeeeeeaas 19 9 1 View ENSJCUI Bali RRRRRRRRRRRRRRRRRRRRR EmEAmSmRmRm WMM 21 9 2 Corrective Action NotifiCation cccccccccccsseccecesecesceeceeceesceeceaseceesaueceesseeeeesseeeeeeseueeessaeeeesseneeeesseeeeeas 22 10 Flow Chart Hazard Incident Report ccccccceescceccseeeeeeeeeeeeeeeeeeeseeeeeeeeeseeeeeeeeesaaeeeeeesseaeeeeeessaaeeeeeesaaeees 23 11 ASTON OIE OM WO TT T O 24 HRD WHS GUI 222 7 Hazard Incident Report Form U2. Lost Time Injury An injury incident that has resulted in no treatment being provided First Aid An injury incident that has resulted in treatment of First Aid Intend to seek medical Treatment An injury has occurred and treatment will be sought in the near future such as doctor hospital physiotherapy chiropractic etc Medical Treatment An injury incident that has resulted in treatment of a trained medical practitioner excluding First Aid Officers Lost Time Injury An injury incident that has resulted in time lost from work of one day shift or more Date ceased work The date which the casualty did not return to work due to the incident If the treatment type is Medical Treatment or Lost Time Injury call the WHS Unit on ext 3931 to discuss reporting a Workers Compensation claim 6 3 Injury Details Choose from the drop down lists what information best describes the nature mechanism and agency of the injury Injury Details HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 11 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide Nature of Injury Disease Select the type of injury sustained Bodily Location of Injury Disease Select the body location where the injury was sustained For more than one injury select multiple locations Mechanism of Injury Disease Select the main means by
3. the View Doc column to open the report Heview contents of each page of the report Note to navigate each page click on the Next button located at the bottom right of the screen Consider if there is sufficient factual information of what has occurred the risk rating appropriate for the incident the report been sent to the right area who is responsible to fix the problem the correct cause been identified the corrective actions fix the causes identified Continue to the Review and Comment page under the Submit Incident Details section there are two options Select the Confirmation of incident to WHS Unit option to approve the report and send to the WHS Unit for authorisation You can add any comments as appropriate and then click on the Submit button To request a modification to a Hazard and Incident Report 1 RN Open your Work List Find the relevant Hazard and Incident Report in your Work List and click the document icon under the View Doc column to open the report Review contents of each page of the report Note to navigate each page click the Next button located at the bottom right of the screen Consider if there is sufficient factual information of what has occurred the risk rating appropriate for the incident the report been sent to the right area who is responsible to fix the problem the correct cause been identified the corrective actions fix the causes identified Navigate to the Correcti
4. P G Student U G 7 Visitor A Staff Search iui ed Organisation To change a staff member select the Staff Search icon above the Surname field The Employee Details window is opened allowing the user to search the UOW personnel listing by name Employee Details Famiy ame ewm In the Family Name or Given Name s fields enter either the full name or part thereof and click the Search button to display a list of employees with that name Entering part of a word such as smi returns the results omith Smithers Goldsmith etc Select the desired name from the list displayed If the name is not on the list close the Employee Details window and enter the injured person s details manually as per the following instruction for Student or Visitor If the Person Type is a Student or Visitor enter their name If the Person Type is a Contractor enter their name and the name of the Organisation that they work for HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 10 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide 6 2 Level of Treatment Select the most appropriate option for the level of treatment for the injured worker Note only one option can be selected Level of Treatment None c First Aid J Intend to seek Medical Treatment E Medical Treatment
5. a Modify and Remove button Clicking the Modify link reopens the Corrective Action Details window from where you can make amendments The Remove link removes the action required from the Incident Hazard Where responsibility of the corrective action is in doubt contact the WHS Officer to assist with the identification of the most appropriate unit responsible for the corrective action Once all information has been entered click the Next link The Review and Comment page opens Review and Comment Review Summary View Status History No review comments have been recorded HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 18 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide 8 Submitting the Form Once all information has been entered the form can be submitted to the nominated supervisor by clicking the Submit button The confirmation window then displays SafetyNet Hazard and Incident UNIVERSITY OF WOLLONGONG aa E Work List i Incident Hazard 33 Risk Assessment E safe Work Procedure B Search Print he document has been saved in SafetyNet Reference No SF HIR 14 0006 A If you would like to View Print this document please click here hi you would ike to copy this Incident Hazard report to create a new Incident Hazard Report please click here If required fields have not been c
6. form is automatically populated The Ref No field is blank until the form has been submitted and allocated a reference number This information displays at the top of each page The Status field displays Initial The Date Created field is populated by the date the form is opened Form Details HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 3 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide 3 2 Person Completing the Incident Hazard This should be the details of the person who is reporting the incident Note that the person submitting the form does not have to be the injured person if this is an Injury Incident A report may be taken over the phone or by writing The form automatically populates a number of fields for staff including Date entered Person type Personal information of the person completing the form including their immediate supervisor Person Reporting the Incident Hazard Date Entered 44022014 Entered By Glenn Blackley Ej E Confidential Person Type 1 Casual e Contractor Employee Part time Student P G O Student U G Visitor B Staff Search stare sane Email gblackie uow edu au Job Title Technical Writer Only select the Confidential option if the nature of the incident requires it e g to report bullying or h
7. moderate or heavy rain fall occurs HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 14 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide Inappropriate actions Were there any behavioural aspects which were the underlying causes of and or behaviour the incident hazard For example staff member stood on a table to remove a light bulb and fell failure to comply with safe work procedures student was intoxicated and fell over student smoking in building doorway fumes from workers laying carpet tiles workmen left rubbish in corridor cylinders stored inappropriately researchers travelling with dry ice in elevator Lack of or inadequate Were there systematic or procedural causes leading to the incident For management system example lack of training given prior to use of new equipment no workplace inspection carried out Other contributory e tagging required issues unauthorised modification of the experimental setup unknown none 7 2 Cause of Hazard Incident In this section enter the known cause s of the hazard incident occurring e g tripped down the stairs due to raised carpet tile Cause of Incident Hazard 7 3 Risk Assessment In this section the risk relating to the hazard is assessed Two parameters influence the risk score Consequence and Likelihood Consequence selections are de
8. uow edu au HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 19 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide The supervisor is required to review the document and consider if there is sufficient factual information of what has occurred the risk rating appropriate for the incident the report been sent to the right area who is responsible to fix the problem the correct cause been identified the corrective actions rectify the causes identified All persons listed as approver s on the form have two options to approve the document or to return it to the work group Approve the document selecting the Approve Document option confirms that the user has reviewed the document and is approving the document for use at UOW Return the document to the work group select the Return to Developers option when the person who is approving the document has identified that the document requires modification before use at UOW The approver is required to input a comment regarding the improvements that are required Review and Comment SF HIR 14 0009 Status ShortFie Date Created 21 02 2014 Confirmation of incident to OH amp S Unt Comments Review Summary No review comments have been recorded The supervisor may approve the document or return the documen
9. which the injury occurred Agency of Injury Disease If appropriate select a secondary means by which the injury occurred These fields are required for the form to be saved 6 4 Description of IllIness Injury In this section provide a description of the injury s sustained in the incident For example a broken right leg Keep the description brief If further information is required attach a statement in the Attachments section Description of Illness Injury Specific task being performed at time of Incident Injury Description of Treatment Provided Is there any information that should NOT include Private information should not be included such as Names Addresses Phone numbers of people involved Details of conversations Nature of injuries 6 5 Specific task being performed at time of Incident Injury In this section provide a description of what the person was doing when the injury was sustained For example walking down the stairs tripped and fell HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 12 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide 6 6 Description of Treatment Provided In this section provide further information on what treatment if any was provided For example first aid treatment provided or ambulance called and took injured to casu
10. 2010 Manager WHS Document updated with minor amendments as per review schedule Title changed from SafetyNet user guide to delineate from other modules of SafetyNet name change to Human Resources Division Leer humor aaa EE occ ME ee eee HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 24 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version
11. Assistance Program Workplace Health and Safety Awards Award Recipients Consulting on WHS Matters WELL WORK QUICK LINKS Managing Risk Use the following inks to well work gt A big thank you to the 260 plus survey participants who took the time to provide ther views on M wellbeing issues and initiatives to support healthy lifestyle behaviours To see more detailed s anaging injunes d results from the check out the welld gt work internet page SAFETYNET Emergency Management gt ACCESS Working Safely at UOW Satety Training and Courses b GCC ENERGY About the WHS Unit AUS STANDARDS ACCESS HOW TO REPORT A ML MR L HAZARN NR INCIDENT ie We 3 10 gt iT randi WHS FORMS The Staff Intranet page also has links to SafetyNet Another way of accessing SafetyNet is via a hyperlink contained within an email notification or corrective action reminders which are generated after a hazard incident has been reported Once the user has entered the site via their University logon name and password the Work List page is displayed be completed The icon to the right of this incident Hazard allows for the user to enter a new hazard incident report HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 2 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Gu
12. UNIVERSITY OF x2 WOLLONGONG y WHS UNIT HAZARD INCIDENT REPORT FORM USER GUIDE Contents 1 ATO olt e HO Misc TRO EE EE T ET T PEE T E TA P IEE E E E TE 2 ZEN Yee tels MM 2 3 Reporting an Incident ssseessissssssssseseeseeee nennen nennen nnnm nnn nns nna nnne ss sna nnn nsns sna n inris nna n nnns nnns 3 3 1 Reference Information cccccccccssccccescecceseeceeececseeeeceeeeeceucessaeeessaecessaeeeseeeesaueessaeeessaeeeseueesseeesseeeeesanees 3 3 2 Person Completing the InCiIdD nt HAZard cccccccccccsesseceeeceeeeeeeeeeeeeseeeeecseeeeeeeessesseeeeesaeaseeeesssageeeeessaaees 4 3 3 Report To Be Sent T0 cccccecccccccsessseeeccaeeeeceeecaesseceeecseaeeeeesseaeceeeseaaseceeseeaueeceesseaaeeeesssaaaeeeeeesssageeeessaas 4 3 4 Occurence Type m TII 5 3 5 ncident Classification ERROR om 5 4 Reporting a Hazari m e OYOO ri 4 1 mire EI e METTE M 7 4 2 incident Hazard Breq oi m 8 4 3 PU AG MTA ANS NINE ER LE 8 4 4 HCE durs lS M D ct eee ene To OO OS eee ee ea eee ee nee 9 4 5 Saving the nciaent Type ac 0 gt Annee en een ot ey ee ee ee ae ne eer ee ee mene eee 9 S ROMANE ISS deus setae mmm 9 C ROPO Ee I yer arses ere eaardatercess a E E A 9 6 1 SG AP CES ON TE mE 10 6 2 POV GOR MM Um 11 6 3 AY AB m
13. alty 6 7 Name of UOW First Aider If First Aid was selected in treatment type enter the first aider s details in this field e g Joe Bloggs First aider This does not need to be a nominated first aider Name of UOW First Aider tane D 6 8 Name of Treatment Provider If Medical Treatment was selected in treatment type enter the treatment provider s details in this field e g Dr Mary Jones G P Name of Treatment Provider Once all the required fields are entered click Next to proceed to the Corrective Actions page HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 13 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide 7 Corrective Actions 7 1 Possible Contributing Factors When trying to determine corrective actions to prevent reoccurrence it is helpful to analyse the causes that led to the incident occurring From the options presented select the factors which best describe the underlying cause of the incident hazard and enter a description At least one factor that caused the incident must be selected Contributing Factors Lack of or inadequate plant equipment Lack of or inadequate procedures instructions Lack of or inadequate training Lack of or inadequate management supervision Inappropriate or inadequate work en
14. arassment By selecting the Confidential option the report form bypasses the Supervisor and is reported only to the WHS Unit Students contractors visitors and staff whose employee number has not been updated in the system are required to enter these details in manually To do so the appropriate Person Type should be selected these fields are dynamic and allows for the required fields to be entered manually Person Reporting the Incident Hazard Date Entered 14 02 2014 Entered By E Confidential Person Type C Casual Contractor Employee Part time Visitor Shs nen A AR A E A iw EE wm ii Ta Organisation The Staff Search link allows the user to search the UOW personnel listing by name These fields must be completed for the form to be saved 3 3 Report To Be Sent To The Hazard and Incident report form is required to be submitted to the Supervisor who has responsibility for the area or process Report to be sent To Supervisor Darren Smith a Change Supervisor p de X Remove Supervisor s If the responsible supervisor is different than the person completing or listed on the form click the Change Supervisor link The Supervisor Details window opens HRD WHS GUI 222 7 Hazard Incident Report Form User G
15. can be seen in the below table Extreme At least one action must be completed to reduce the risk to an acceptable level immediately High At least one action must be completed to reduce the risk to an acceptable level within 24 hours acceptable level within 2 weeks At least one action must be completed to reduce the risk to an acceptable level within 4 weeks Negligible Not applicable HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 16 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 7 4 Corrective Actions Corrective Actions Add Corrective Action Plan Click the Add Corrective Action Plan button to add any corrective actions The Corrective Action window opens Corrective Action Details Can this risk be eliminated Yes No Hd Pree see Corrective Action Description Responsibilities and Timeframes Responsible Target Date E S Date Completed dS REN ance If the hazard in the incident being reported can be eliminated select the Yes radio button and proceed to complete the Corrective Action Description field If not select one or more controls from the Control Type drop down list and proceed to complete the Corrective Action Description field The Control Type field allows for the recording of corrective actions following the hierarchy of controls The h
16. d in the comments and the reasons why Click the OK button once completed Click the Save button View Status History or Cos itam r status History link to see the document process and previous reviews of the document HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 21 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide Document Status There are three status types in the Hazard and Incident Form Status Description 1 0 10 10 0 0 0 O Short file The document is in its initial stage and is incomplete Open The document has control actions assigned that have not been completed One or P more control actions are assigned to a person responsible with a target date When all control actions are complete the status changes to Closed 9 2 Corrective Action Notification Once a report form has been authorised emails are sent to each person who has a corrective action The email includes a link to SafetyNet which details the corrective action information When the corrective action has been completed by the person responsible the date completed field can be entered which closes out the action When all corrective actions are completed for an incident the hazard report is finalised If a corrective action has not been completed by its target completion date a reminder email wil
17. d you are reporting from the drop down list Classification Category Exposure or Contact e Animals Insects Spiders etc e Biological substances e Chemicals e Contact with electricity e Psychological or physical factors e Radiation e Sound or vibration e Temperature e Unspecified contact e Hitting objects with any part of the body Lifting or carrying objects No objects being handled Other handling of objects Overuse injuries Muscular stress From Height Involving stairs On the same level Workplace Environment Ergonomic factors Layout Lighting Ventilation Once completed select an appropriate category from the drop down list and if applicable a sub category unless greyed out These fields must be completed for the form to be saved HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 7 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide If a suitable classification category is not available in the Classification field select Other from the drop down list and manually enter the hazard classification in the Other field 4 2 Incident Hazard Description Enter a factual description of the incident hazard in this section If you did not actually witness the incident or event you may still write an Incident Hazard Report however be sure to state the information is based on what was rep
18. ena Property damage caused by persons is generally categorized by its cause neglect including oversight and human error and intentional damage Security Breach Any incident that results in unauthorized access of data applications services networks and or devices by bypassing their underlying security mechanisms material oystem Failure The condition in which a system no longer performs the function it was intended to or is not able to do so at a level that equals or exceeds established minimums For information on reporting a hazard or a near miss refer to Sections 4 and 5 respectively For information on reporting an injury refer to Section 6 HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 6 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 4 Reporting a Hazard After Hazard has been selected in the Occurrence Type section proceed to the Hazard Classification section 4 1 Hazard Classification Under Classification choose the most appropriate selection for the hazard you are reporting Once completed select an appropriate category and if applicable sub category Occurrence Type Classification Category Sub Category Other This field must be completed for the form to be saved Under the Classification field choose the most appropriate selection for the hazar
19. ide 3 Reporting an Incident There are three main types of occurrences that can be reported in the system Hazards Near Misses or Incidents injuries gblackle Either can be entered by clicking incident Hazara which opens the Form Details page SafetyNet Hazard and Incident UNIVERSITY OF G WOLLONGONG Work List A Incident Hazard p Risk Assessment E Safe Work Procedure GA Search Print 2 Help 3K Corrective Actions 3K Review and Comment As you complete the e Form additional sections will appear in the menu above You may switch between the different sections of the e Form using the menu As you fill out the sections the icon beside the section in the menu will indicate the status of that form 3K Incomplete v Complete t Contains an error All sections must be complete to submit the e Form Form Details Ref No EET Status Initial Date Created Person Reporting the Incident Hazard Date Entered i Staff Search First Name s Surname Email Job Title Technical Writer Report to be sent To a im ee E Acs MM Supervisor s Occurrence Type Incident Hazard Description Attachments Description Incident Hazard Details Date of incident Hazard 14 02 2014 Time of Incident e Date Reported Reporte To Entering a Hazard and Incident Form requires the following information to be entered in the Form Details page 3 1 Reference Information This section of the
20. ierarchy of controls is as follows Eliminate or remove the hazard Substitute the hazard for something with less risk Isolate the hazard by placing a barrier between the hazard and people Engineer or Redesign the hazard by changing equipment or process Administration i e training signage or safe work procedures Personal Protective Equipment the use of gloves glasses hearing protection etc aS I Each type of control must be considered in turn commencing with elimination If a control is not reasonably practical then the next one should be considered and so on For example if a hazard cannot be eliminated then the user should assess if it can be substituted and so on Enter a description of the Corrective Action taken For example Use an alternate chemical that is less hazardous In the Person Responsible field click the Search icon to locate the name of the person assigned to undertake the corrective action The Search icon opens the Employee Details window is opened allowing the user to search the UOW personnel listing by name This search is similar to person search however only authorised supervisors and academic staff are contained in the list In the Family Name or Given Name s fields enter either the full name or part thereof and click the Search button to display a list of employees with that name Entering part of a word such as smi returns the results Smith Smithers Goldsmith etc Select the desired na
21. l be sent weekly HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 22 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 10 Flow Chart Hazard Incident Report Responsibility Originator Originator Supervisor WHS Unit Supervisor WHS Unit WHS Unit Supervisor WHS Unit WHS Unit WHS Unit WHS Unit WHS Unit Person Responsible HRD WHS GUI 222 7 Create the report Submit the report for review amp approval SS ae ne O Review the report for Preliminary quality amp accuracy review l eee l I Yes Modify Amend Modify 1 document report document 7 P I Yes ik Y l PPP A A Provide Return to l paan i d a originator 1 Y Yes Yes No Await supervisor b Review the report for quality amp p review accuracy P l i l Yes No Modify Modify amp document save No Corrective actions assigned Corrective actions completed Hazard Incident Report Form User Guide 2014 March Page 23 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 11 Version Control Table Version Date Released Approved By Amendment zem m 2006 Manager WHS Document updated with minor amendments eer
22. losion Injury Motor Vehicle Accident Personal Threat Plant Equipment Damage Plant Equipment Failure Property Damage Security Breach Attach File Spil Release System Failure Classification Explanation Environmental Damage Any change or disturbance to the environment perceived to be harmful or undesirable Fire Explosion A fire is a process in which substances combine chemically with oxygen from the air and typically give out bright light heat and smoke combustion or burning An explosion is a violent release of energy resulting from a rapid chemical or nuclear reaction especially one that produces a shock wave loud noise heat and light Injury Physical harm to a person s body Common types of physical injury are broken bones cuts poisoning and burns Injury results from harmful contact between people and objects substances or other things in their surroundings Motor Vehicle Accident The unintended collision of one motor vehicle with another a stationary object or person resulting in injuries death and or loss of property Personal Threat Refers to a situation action individual or object that may harm a person It is a threat that affects the individual and threatens the security or performance of duties by that person spoiled or injured be due to defects or improper use Property Damage Damage to or the destruction of public or private property caused either by a person who is not its owner or by natural phenom
23. lty Select appropriate Faculty Division Department Unit Select appropriate Unit These fields must be completed for the form to be saved 4 5 Saving the Incident Type Page Once all the necessary information has been entered click Next to continue to the next page When the page has successfully been saved the Corrective Action page opens See section 8 of this guide for further information relating to this section 5 Reporting a Near Miss Reporting a near miss is the same as Reporting a Hazard except that there is no hazard classification section required to be completed 6 Reporting an Injury The Injury Details page is only displayed if the Occurrence Type selected is Incident and the With Injury option is selected HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 9 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 6 1 Injured Person Complete the information required for the person who was injured in the incident The default information is the same as the person completing the form If this is different from the person completing the form amend the details by changing the person type and entering the information as required This section is dynamic depending on the Person Type selected Injured Person Person Type i3 Casual Contractor Employee Part time Student
24. me from the list displayed Email details should automatically appear once the person has been selected HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 17 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide The Target Date is the date by which the corrective action is to be completed The date generated will reflect the timeframe of the risk rating The Date Completed can be used if the corrective action has been completed prior to the completion of the incident report Once all information has been entered click the Save link The details are updated in the Corrective Actions section For each control measure selected in the Hierarchy of Control section a corrective action must be added into the corrective action plan iControl Type Action Description Person Responsible Target Date Date Completed i E Use an alternate chemical that is less a Modify 2 Substitution aiik David Smith 3 03 2014 S Remove Add Corrective Action Plan Click the Modify on the right of the page to add detail to the corrective action Additional corrective actions can be selected by clicking the Add Corrective Action Plan button Once you have entered the details of an action an action summary appears in the Action Details section Each action will appear as a row in the summary table Each row will have
25. n of With injury or Without injury and the Incident Classification section displays below Selecting the With Injury option adds the Injury Details page to the Menu Hazard A source or a Situation with a potential for harm in terms of human injury or refer Reporting a Hazard ill health damage to property damage to the environment or a combination of these When Hazard is selected you are presented the Hazard Classification section displays below Near Miss An incident that could have led to unintended and or unnecessary harm to refer Reporting a Near Miss a person and or a complaint loss or damage When Near Miss is selected you are presented the Hazard Classification section displays below The form is dynamic in the sense that depending on the type of occurrence the form asks different questions 3 5 Incident Classification This section only displays if you have selected Incident as the Occurrence Type You must select an appropriate category from the drop down list HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 5 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide Incident Hazard CNearMss 1 With injury Without injury Incident Classification Classification Incident Hazard Descripth Environmental Damage Fire Exp
26. ompleted the form cannot be submitted Pages marked with a star and fields outlined in red need to be completed prior to allow for successful submission If you have any queries regarding submitting the form contact the WHS Unit on extension 4365 9 Supervisor Notification Once the hazard incident report form has been successfully submitted the nominated supervisor receives an email The email directs the supervisor via a link to the online report form for review and approval The incident hazard report has been submitted and requires your review Reference SF HIR 14 0015 Description Ergonomic Assessment Staff member Risk Score Low The incident hazard report can be accessed from your Work List https sbcit com au IncidentForm WorkList Default aspx To review 1 Open your work list 2 Click on applicable reference number to open the document 3 Review the contents of each page of the document Note To navigate each page click on Save located at the bottom right of the screen Your review process should consider sufficient factual information has been recorded about the incident hazard there are corrective actions that are designed to eliminate or control the hazard 4 On Corrective Actions page click on Submit Complete Submit Incident Details screen and click Submit If you are unable to access SafetyNet or would like to discuss this issue with the WHS Unit contact us on phone 42213931 email ohs admin
27. orted to you and by whom it was reported If you do not feel that you have factual information you may state your opinion provided that you indicate that it is your opinion and not fact Even if the actual cause of the incident remains unknown after you have attempted to determine it you should provide as much information as you have concerning what happened prior to the event during the event as this may provide a clue to the reader This field must be completed for the form to be saved Incident Hazard Description When you are reporting an incident it is important to provide the reader with adequate information including e Nature of incident e Tasks activities occurring at the time e Exactly what happened i e the direct cause of the accident electric shock sharps injury exposure to a particular agent slip struck by a door etc e Control measures in place at the time local exhaust ventilation PPE e Details of witnesses involved e The immediate action taken for the incident Remember the information contained in the incident description should be relevant This information is made public with UOW Is there any information that should NOT include Private information should not be included such as Names Addresses Phone numbers of people involved Details of conversations Nature of injuries 4 3 Attachments Associated files may be attached to the report which allow the supervisor or the WHS Uni
28. pendant upon what level of medical treatment is expected to be needed for an injury from this hazard Likelihood selections are dependent upon the probability that the consequence will eventuate Risk Consider the Consequences What are the consequences of an incident occurring from the hazard Consider what could reasonably have happened as well as what actually happened Look at the descriptions and choose the most suitable Consequence HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 15 of 24 Hardcopies of this document are considered uncontrolled please refer to VOW website or intranet for latest version Hazard Incident Report Form User Guide Consequence Description Severe Death or extensive injuries Consider the Likelihood What is the likelihood of the consequence identified happening Consider this without new or interim controls in place Look at the descriptions and choose the most suitable Likelihood Likelihood Description A The event is expected to occur The event is likely to occur in most circumstances C The event could occur sometime LEN The event may occur but probably never will Once both consequence and likelihood has been selected the risk score is automatically displayed The risk score is determined from the risk matrix which can be viewed by click information in the Risk Assessment window Depending on the risk score the timeframe for corrective action will vary as
29. ser Guide 2014 March Page 1 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide 1 Introduction SafetyNet is a web based system designed to record hazards and incidents which occur at the University of Wollongong The online form replaces the previous paper form and allows for a variety of advantages including The ability to complete the form online like most other processes in the university environment Direct reporting to supervisors The management of corrective actions utilising email and reminders based on risk The availability of a risk register This Guide was developed in order to assist users complete the UOW SafetyNet online hazard and incident reporting form The principles associated with hazard and incident reporting can be located in the Hazard and Incident Reporting Guidelines 2 Accessing SafetyNet SafetyNet can be accessed a number of different ways The main way users can access SafetyNet is via the link from the VOW WHS Page AtoZ Campus Map Staff intranet Contacts UNIVERSITY OF WOLLONGONG amp AILUOW WHS Unit o FACULTIES i CANADY If P IOASCCPAATE AR pem VISIONARY DYNAMIC PASSIONATE CONNECT UO N UOW gt Statt gt WHS Unit Dur Commitment to Safety WHS Management System WHS Policy WHS Responsibilities Other WHS Poticies Contractor Satety Employee
30. t to the originator A comment must be entered as to why it is being return and what needs to be fixed Review and Comment Ref No SF HIR 14 0011 Status Date Created 21 02 2014 Review Summary View Status History istory Comments This incident requires further details about what occurred The supervisor can change detail in the report form or may request that the report form is sent back to the originator so that changes can be made If changes are required an email with any comments is sent back to the originator The developer will be prompted to access the file via their Work List Specific items which a supervisor should review to ensure they have fulfilled their responsibility is to ensure that any hazards have been suitably identified and those corrective actions are suitable to reduce the risk of injury When an approver returns the documents to developers they are required to enter a comment on the document The comments are stored under History Comments in the Review Summary section to allow the reader to view HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 20 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide To approve a Hazard and Incident Report o Open your Work List Find the relevant Hazard and Incident Report in your Work List and click on the document icon under
31. t to view Files may include photos witness reports previous hazard reports emails or other documents Attach File Browse Description Remove To include a file click the Browse button and find the file you wish to add Once the file has been selected click the Add button to insert the file to the report HRD WHS GUI 222 7 Hazard Incident Report Form User Guide 2014 March Page 8 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide Once the file has been successfully inserted into the report the appropriate information should be displayed under file name A description can be inserted and the file can be viewed or removed by choosing the appropriate icon 4 4 I Incident Hazard Details Record the specific details in relation to the Incident Hazard Incident Hazard Details Date of incident Hazard 14 02 2014 EE Time of Incident Date Reported 4 EE Reported To Location of Incident Hazard Building Specific Location Executive Faculty Division Department Unit Field Name Comments Date of Incident Hazard The date the hazard was first identified Time of Incident The time the hazard was first identified Date Reported The date the hazard was first reported to the supervisor completion of this hazard report Executive This is automatically populated based on the Faculty Division selected Facu
32. uide 2014 March Page 4 of 24 Hardcopies of this document are considered uncontrolled please refer to UOW website or intranet for latest version Hazard Incident Report Form User Guide Supervisor Details Search Clear Cancel In the Family Name or Given Name s fields enter either the full name or part thereof and click the Search button to display a list of employees with that name The letters smi returns the results Smith Smithers Goldsmith etc Select the most appropriate supervisor from the list displayed Supervisors must be staff Additional supervisors can be added by clicking the Add link the Supervisor Details window open and complete as above Note that only the primary supervisor receives the incident to modify Additional supervisors receive an electronic copy of the hazard incident report via an email which includes a PDF attachment This field must be completed for the form to be saved unless the Confidential option has been selected By selecting the Confidential option the report form bypasses the Supervisor and is reported only to the WHS Unit 3 4 Occurrence Type This section of the form enables the user to select the most appropriate occurrence type i e hazard near miss or incident Incident Any physical or mental damage to the body caused by exposure to a hazard where the employee s employment was a significant contributing factor When Incident is selected you are presented the optio
33. ve Actions page of the report If further corrective actions are required click the Add Corrective Action Plan button in the bottom right hand corner The Corrective Action Details window opens Complete the corrective action details Consider that the corrective actions should control the cause of incident they should be designed to eliminate or control the hazard Click the Save button To add another corrective action repeat steps 4 to 6 After all corrective actions have been added continue to the Review and Comment page Under the Submit Incident Details section there are two options Select the Request modification to form by originator option to return the report to the person that reported the incident hazard to make changes The report will then be sent back to them for modification 10 Once you have selected the appropriate action click the Submit button To close the corrective action 1 2 9 1 From the Review and Comment page click the Open your work list Find the relevant Hazard and Incident Report in your Work List and click the document icon under the Corrective Action column The Corrective Action Outstanding window opens If the corrective action has been executed close out the corrective action by entering the date the action was completed in the Date Completed field If you wish to enter a comment click the Add Comment link and enter the details in the Enter Comments field Any deviations should be recorde
34. vironment Inappropriate actions and or behaviour Lack of or inadequate management system Other contributory issues Lack of or inadequate What elements of the process equipment s manufacture or design led to plant equipment the injury For example fault with original design of equipment jnadequate fail safe controls possible equipment malfunction Lack of or inadequate Was there a lack of procedures or instructions that led to the incident procedures instructions For example here was no risk assessment undertaken for the task he Safe Work Procedure failed to identify some hazards Lack of or inadequate Was there a lack of training that led to the incident For example training student had not been inducted in use of equipment contractor was unlicensed to operate forklift Lack of or inadequate Was there a lack of management or supervision that led to the incident management For example supervision student did not discuss with appropriate supervisors the nature and risks of chemicals used Inappropriate or Were there any factors in the environment which led to the injury For inadequate work example environment rainy weather causing flooding poor lighting loose pavers on pathway asbestos found in laboratory heat discomfort from lack of air conditioning ergonomic review of workstation setup following back pain inappropriate storage of equipment and materials obstructing fire door roof leaks water whenever
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