Scribd Logo
Upload

Welcome to Scribd!

  • 11 - SITXWHS005 - Appendix A

    Uploaded by

    Stacy Parker
    60 views3 pages
    John Henry fell from a trestle ladder while retrieving ingredients from a shelf in the store room of Orange Café. He sprained his leg and neck in the fall. The incident was reported to the manager, Ritik, at 10 AM on May 25, 2023. To prevent future incidents, recommendations include using personal protective equipment, taking precautions when working near fragile surfaces, and controlling hazards.

    Original Description:

    11- SITXWHS005 - Appendix A

    Original Title

    11- SITXWHS005 - Appendix A

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    John Henry fell from a trestle ladder while retrieving ingredients from a shelf in the store room of Orange Café. He sprained his leg and neck in the fall. The incident was reported to the manager, Ritik, at 10 AM on May 25, 2023. To prevent future incidents, recommendations include using personal protective equipment, taking precautions when working near fragile surfaces, and controlling hazards.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    60 views3 pages

    11 - SITXWHS005 - Appendix A

    Uploaded by

    Stacy Parker
    John Henry fell from a trestle ladder while retrieving ingredients from a shelf in the store room of Orange Café. He sprained his leg and neck in the fall. The incident was reported to the manager, Ritik, at 10 AM on May 25, 2023. To prevent future incidents, recommendations include using personal protective equipment, taking precautions when working near fragile surfaces, and controlling hazards.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    SITXWHS005

    Appendix A – Incident Report Template

    Incident report

    Details of the injured person

    Surname: henry First name: John

    Telephone no: 789654123 Phone: 5698 562 569

    Details of incident/accident

    Date of injury/incident/accident: 25.05.2023 Time of discovery: 10 AM

    Address: Orange Café

    Details of injury/hazard/incident/accident
    John has fallen from the trestle ladder while taking the ingredients from the shelf.

    Location of incident: store room

    Nature of injury: leg and neck are sprained.


    Describe the circumstances of the incident/accident.

    Description of hazard/incident/accident:

    Description of hazard/incident/accident:

    Fall from height

    First aid measures: ambulance called

    Version: 1.0 – Sep 2022 Gen Institute Pty Ltd © Page 1 of 3


    SITXWHS005

    Name(s) of witness(es): Ritik Signature of witness(es): Ritik

    When was the injury/hazard/incident/accident reported?


    Date: 25.05.2023
    Time: 10 AM

    Who was the injury/hazard/incident/accident reported to?


    Name: Ritik
    Position: Manager
    Proposed recommendations

    Actions to reduce the incidents:

    Use PPE and precautions

    Action to control incidents (suggestions from others)

    Details of preventative measures suggested:

    take precautions when working on or near fragile surfaces;

    Signature: Ritik Date: 25.05.2023

    Version: 1.0 – Sep 2022 Gen Institute Pty Ltd © Page 2 of 3


    SITXWHS005

    Version: 1.0 – Sep 2022 Gen Institute Pty Ltd © Page 3 of 3

    You might also like