Safety Report Completion and Circulation Guide

Safety Report Type Identification and Sign Off Level

Safety is Everyone’s Responsibility
Safety Report Description Sign off Level
Type Description Sections Supervisor Senior Dept
Part of this responsibility is the reporting of to Supervisor Manager
Complete
safety incidents and issues. Not only will this Personal Hospitalisation. The injured person 1,2,3,5,6 HIGH
make the workplace a safer place in which to Injury has been admitted to hospital as
an in-patient.
work, it will help keep people informed. Personal Medical Centre/Ambulance 1,2,3,5,6 HIGH
Injury Treatment. The injured person has
been treated at an off-site medical
centre or has been treated by an
ambulance officer either on site or
Safety Report Flow Chart off site.
Personal First Aid Treatment. Injured person 1,2,3,5,6 HIGH
Injury has been treated at on-site first aid
centre or by a first aid kit.
Property Can not continue Normal & Safe 1,2,4,5,6 HIGH
Damage Operation.
Operations have stopped and
repair costs will be greater than
$5000
Property Can be Reinstated to Normal & 1,2,4,5,6 MEDIUM
Damage Safe Operation. Operations have
stopped but can be reinstated
within 1 hour and repair costs are
under $5000.
Property Minor or No Interruption to Normal 1,2,4,5,6 LOW
Damage & Safe Operation.
Dangerous Includes – Electric Shocks & 1,2,5,6 HIGH
Event Isolation Breaches. The potential
will always be HIGH
Illness Illnesses Occurring at Work. 1,2,6 MEDIUM
Hazard Sign off will depend on potential, 1,2,5,6 LOW MEDIUM HIGH
HIGH-manager, MEDIUM-senior
supervisor, LOW-supervisor.
Near Miss Sign off will depend on potential, 1,2,5,6 LOW MEDIUM HIGH
HIGH-manager, MEDIUM-senior
supervisor, LOW-supervisor.
Proactive Sign off will be by level of authority 1,2,5,6 LOW MEDIUM HIGH
Event for completion of work.

Potential Identification Chart

When determining Catastrophic Major Minor

Potential, consider how Injury: Admitted to Injury: Treated at an off Injury: On-site first aid
likely the incident could hospital, or is a Lost site medical centre, ie., treatment only, ie., First
result in injury or Time Injury (LTI) Medical Treatment. Aid Case.
damage, and what Damage: Cannot
would be the degree of continue normal and Damage: Can be Damage: No
injury or damage. safe operation. returned to normal and interruption to normal
Cost>$5000 safe operation within 1 and safe operation
hour. Cost <$5000
Very Likely HIGH HIGH MEDIUM
It could happen
frequently.
Likely HIGH MEDIUM MEDIUM
It could happen
occasionally.
Unlikely HIGH MEDIUM LOW
It could happen but rare.
Very Unlikely MEDIUM LOW LOW
It could happen, but
probably never will.

Safety Report Completion Instructions