STUDENT NAME: Ni Wayan Maemuna Febriani

STUDENT NUMBER: 2019061113

COURSE: Provide leadership across organizaion

UNIT OF BSBLSR602
COMPETENCY:

TITLE OF 1
ASSESSMENT TASK:

DATE DUE: 13.10.2022

DATE SUBMITTED: 13.10.2022

Assessment1

Incident report
1. DETAILS OF PERSON MAKING REPORT

Name: Ni Wayan Maemuna Febriani____________________________________________

Position: Operations General manager____________________Job Title:________________

2. DETAILS OF INCIDENT

Date10 June 2022________________________________ Time: 4.30pm____________

Location: The office stairwell in the emergency exist________________________________

Describe what happened and how:

The Client was failing through the emergency exit and stairwell and breaking her wrist.

Because she run with the high heels. Also there are some oily substance on the __________

Stairwell.__________________________________________________________________

It use more time to help the client because the exist door was block by the boxed of ______

Paper and it had to call some person for helping___________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

SUGGEST CORRECTIVE ACTIONS

___Bring the Client to the hospital _____________________________________________

Tidy the box paper to the correct place such as the garbage room ___________________

Should always do identify risk on the site ( which the accident have some cause _______

Which come from lack of identify risk and the staff don’t concern on WHS too much) _____

Report the accident or injure through the CEO _________________________________

__________________________________________________________________________

__________________________________________________________________________

3. DETAILS OF WITNESSES

Name: Ni Wayan Maemuna Febriani ____________

Job title: Operations General manager

Injury report
Status:  Employee  Contractor  Other
Outcome:  Near miss  Injury
1. DETAILS OF INJURED PERSON

Name: Sarah M._______________________ Phone: (H) 02-9456007 (W) -

Address: 232 George st. ___________________________Sex:  M  F

_______________________________________________Date of birth: 12 May 1980_____

Job Title: Banker____________________________________________________________

Start time: -_________________________________________ am  pm

Work arrangement:  Casual  Full-time  Part-time  Other

2. DETAILS OF INCIDENT

Date: 10/06/2022__________________________ Time: 4.30 pm_________________

Location:

Max Lional office stairwell emergency exit

Describe what happened and how:_______________________________________________

The Client was failing through the emergency exit and stairwell and breaking her wrist.

Because she run with the high heels. Also there are some oily substance on the __________

Stairwell.__________________________________________________________________

It use more time to help the client because the exist door was block by the boxed of ______

Paper and it had to call some person for helping____________________________________

3. DETAILS OF WITNESSES

Name: Ni Wayan Maemuna Febriani Phone: (H) __________________ (W)____________

Address: ___________________________________________________________________

__________________________________________________________________________
4. DETAILS OF INJURY

Nature of injury (e.g. burn, cut, sprain) Broken_____________________________________

Cause of injury (e.g. fall, grabbed by person) fail on stairwell_________________________

Location on body (e.g. back, left forearm) whist____________________________________

5. TREATMENT ADMINISTERED

First aid given  Yes  No

First aider name:_____________________________________________________________

Treatment:__________________________________________________________________

Referred to:_________________________________________________________________
SECTIONS 6–9 MUST BE COMPLETED BY EMPLOYER

6. DID THE INJURED PERSON STOP WORK?

 Yes  No If yes, state date:____________________ Time:_____________

Outcome:

 Treated by doctor  Hospitalised  Workers compensation claim

 Returned to normal work  Alternative duties  Rehabilitation

7. INCIDENT INVESTIGATION (comments to include causal factors):

The injure was because the client wear high heels. Also there are some oliy substance_____

On the stairwell______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________
8. RISK ASSESSMENT

Likelihood of recurrence: H____________________________________________________

Severity of outcome: _________________________________________________________

Level of risk: H______________________________________________________________
9. ACTIONS TO PREVENT RECURRENCE

Action By whom By when Date completed

- Meeting with Site Ni Wayan Maemuna 10th June 2022 10th June 2022
Manager, Max Febriani
( COE) and WHS
committee talking
about what happen
and the solution
method

10. ACTIONS COMPLETED

Signed (Manager):John________________________________________________________

Title: HR manager Date:__________________

 Feedback to person involved Date:__________________

11. REVIEW COMMENTS

WHS committee / staff meeting: Arm____________________________________________

Reviewed by site Manager (signed):____________________________ Date:_____________

Reviewed by Health & Safety Rep.(signed):______________________ Date:_____________

Details

Name: Ni Wayan Maemuna Febriani______________________________________________________

Position: Operatinal manager________________________________________________________

Risk details

Risk ID: 0032____________________________________Number allocated to this risk.

Raised by: Sarah_______________________________Name of person who has raised the risk.

Date raised: 10 June 2022_______________________Date of completion of this form.

Description of risk:
Briefly describe the identified risk and its possible impact.
Lack of concern on the WHS policy and Inadequate insurance cover
Lack of concern on the Risk assessment (As the customer has fail on the stairfire)
Not awareness on the WHS procedure

Likelihood of risk: Impact of risk:

Describe and rank the likelihood of the risk Describe and rank the impact if the risk occurs
occurring (i.e. low, medium or high). (i.e. low, medium or high).
Low High

Risk mitigation
Preventative actions recommended:
Briefly describe any action that should be taken to prevent the risk from occurring.
-● WHS management system in place.

Contingency actions recommended:

Briefly describe any action that should be taken, should the risk occur, to minimise its impact.
- staff training on the incident and WHS and code of practice ( such as hazard in the
workplace)
- Insurance check

Approval details
Supporting documentation:
Details of any supporting documentation used to substantiate this risk.
Incident report through HR manager and board of director

Signature: Ni Wayan Maemuna Febriani Date: 10th June 2022

 Likelihoo Risk response
Impact
Risk d (contingency Responsible
(H/M/L)
(H/M/L) strategies)
The systemic
breakdown in
compliance with Doing WHS HR manager.
the organisation’s M H management in Operational
WHS place manager
management
system
Always check the
insurance for
Indadequate business to cover Operational
L H
insurance cover the injure of manager
employee, client
and tanant
Training and do
the siminar to raise
awareness of, WHS
Physical risk from and other
M H HR manager
accident legislation/codes
of conduct among
agents, clients,
tenants