Assessor Guide

HLTINF006 Apply basic principles and practices of

infection prevention and control

Hazard Report Form

For reporting hazards or a hazardous situation.

Complete this form if you notice a hazardous situation. Rectify the hazard immediately if you are able to
do so and report what action you have taken. If unable to rectify the hazard, state what action you
recommend.

Details of Person Reporting the Hazard

First name: Rebeca

Family name: Raducu

☒Employee
☐Client
☐Contractor/Volunteer
☐Visitor
☐Agency Casual

Position: educator

Department: Click or tap here to enter text.

Contact number: 0575533578

Identify the Hazard

Date hazard identified 27.006.2023

Time hazard identified 12.17pm

Describe the hazard Vomiting on the floor

Location Butterfly room

Why/how is it Cross contamination spread of germs

considered a hazard?

Has the hazard already ☒No

caused any
☐Yes – complete an incident report
harm/injury?

Assess the Risk

The risk rating of a hazard is based on the combination of likelihood, consequence and amount of
exposure to a hazard.

HLTINF006 Apply basic principles and practices of infection prevention and control
CRICOS Provider Code 02934D
Page 1 of 3 RTO Number 121952
 Assessor Guide
HLTINF006 Apply basic principles and practices of
infection prevention and control

 Severity: is a measure of an injury, illness, incidents, or disease occurring. When assessing

severity, the most severe category that would be most reasonably expected should be selected.
 Likelihood: is defined as the potential that an accident will happen that may cause injury or harm to
a person. When making assessment of likelihood, you must establish which of the categories most
closely describes the probability of the hazardous incident occurring.
Consequences Table

 1 and 2 Extreme risk; consider elimination of the activity. Otherwise determine controls that are
reasonably practicable to minimise the risk.
 3 and 4 Moderate risk; determine controls that are reasonably practicable to minimise the risk.
 5 and 6 Low risk; manage by routine procedures.

Risk Assessment Matrix

How severe could How likely is it to be that serious?

the injury be?
Very Likely Likely Unlikely Very unlikely

Death or permanent Click or tap here Click or tap here MODERATE Click or tap here
disability to enter text. to enter text. RISK to enter text.

Long term illness or EXTREME to Click or tap here Click or tap here Click or tap here
serious injury MODORATE to enter text. to enter text. to enter text.

Medical attention and EXTREME Risk Click or tap here Click or tap here Click or tap here
several absentee to enter text. to enter text. to enter text.
days from school or
work
First aid needed EXTREME RISK Click or tap here Click or tap here Click or tap here
to enter text. to enter text. to enter text.

Corrective Action Plan

Please use the Hierarchy of Controls to complete the corrective action plan. Consultation with
management and colleagues will assist in identifying effective controls.
1. Eliminate
2. Substitute
3. Engineering control
4. Administrative control
5. PPE.
Actions Recommended to be Taken By whom? By when?

Cleaning up the vomit educator Right after incident

Making sure the environment is safe and educators After incident

separate the sick child

HLTINF006 Apply basic principles and practices of infection prevention and control
CRICOS Provider Code 02934D
Page 2 of 3 RTO Number 121952
 Assessor Guide
HLTINF006 Apply basic principles and practices of
infection prevention and control

Putting up the signs staff While cleaning

Notify the staff, call parents educators After the incident

Wear appropriate PPE

Have the Control Measures Been Implemented?

Residential Manager or Care Coordinator to complete.

☒Yes
☐No
Provide comments on action taken to remedy the hazard or proposed actions:
Cleaning the area and satisize the surfaces

Name: Rebeca Raducu

Signature: Raducu

Date: 27.06.2023

* Form is to be emailed to the management team

Date emailed: 27.06.2023

Follow Up (Principal or Chairman of the Board Only)

Has the hazard been controlled effectively? What if any follow up action is still required?
Provide training

Is a follow up risk assessment required? ☒No

Click or tap here to enter text. ☐Yes
If Yes:
☐3 months
☐6 months
☐12 months

Has the Risk Register been updated with this ☐No

entry?
☒Yes

Actioned by: Date: 27.06.2023

Centre Manager

HLTINF006 Apply basic principles and practices of infection prevention and control
CRICOS Provider Code 02934D
Page 3 of 3 RTO Number 121952