Incident report

Report an incident: including a near miss even if not injured or no property damage.

Report all injuries and situations no matter how minor, including inappropriate behaviour.

Your employment details
What is the name of the IntoWork business you are working for?
What company or organisation are you working at?
Employment type*
Industry*
What training was provided to you in relation to the report being made?
- Induction training
- Task specific training

Incident details
When did the incident happen?
What time did the incident happen?

: HH

MM
What is the incident?
Type of accident
What happened?
Have you submitted this to your on-site manager, supervisor or coordinator?*
- Yes
- No

Falls from a height
Falls on the same level (including trips and slips)
Hitting objects with a part of the body
Exposure to mechanical vibration
Contact with sharp object
Being hit by moving objects
Exposure to sharp sudden sound
Long term exposure to sounds
Exposure to variations in pressure (other than sound)
Repetitive movement with low muscle loading
Other muscular stress
Contact with electricity
Contact or exposure to heat and cold
Exposure to radiation
Single contact with chemical or substance (excludes insect and spider bites and stings)
Long term contact with chemical or substance
Other contact with chemical or substance (includes insect and spider bites and stings)
Contact with, or exposure to, biological factors
Exposure to mental stress factors
Slide or cave-in
Vehicle accident
Other and multiple mechanisms of injury
Unspecified mechanisms of injury

Fractures (excluding of vertebral column)
Fracture of vertebral column with or without mention of spinal cord lesion
Dislocations
Sprains and strains of joints and adjacent muscles (include acute trauma sprains and strains only)
Intracranial injury, including concussion
Internal injury of chest abdomen and pelvis
Traumatic amputation, including enucleation of eye (loss of eyeball)
Open wound not involving traumatic amputation
Superficial injury
Contusion with intact skin surface and crushing injury, excluding those with fracture
Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive systems (include choking)
Burns
Injuries to nerves and spinal cord without evidence of spinal bone injury
Poisoning and toxic effects of substances
Effects of weather, exposure, air pressure and other external causes not elsewhere classified (includes bends, drowning, electrocution)
Multiple injuries (only to be used where no principal injury can be identified)
Damage to artificial aids
Other and unspecified injuries
Psychological

Deafness
Eye disorders (non-traumatic)
Other diseases of the nervous system and sense organs
Disorders of muscle, tendons and other soft tissues (includes synovitis, tenosynovitis, bursitis)
Other diseases of the musculoskeletal system and connective tissue
Dermatitis and other eczema
Other diseases of skin and subcutaneous tissue
Hernia
Other diseases of the digestive system
Infectious and parasitic diseases
Diseases of the respiratory system (include asthma, legionnaires disease, asbestosis, pneumoconiosis)
Diseases of the circulatory system (include heart disease, hypertension, hypotension, varicose veins)
Cancers and other neoplasms
Mental disorders
Other diseases

Your details