Assessment Method 3: Product based methods – structured activities e.g.

role plays, work

samples, presentation, reports

1. Complete the following incident report form on a worker who had a serious slip
and fall from a stage while moving portable stage pieces to erect a drum riser and the
ambulance had to be called.

Site Name
Mackellar girls campus
Site Phone
0433759028
Site Manager Jonathan jones
Site Supervisor at
time Tim Timson
Site Supervisors
Phone No
0347585904
Date of
Incident/Issue 08/08/22
Time of
Incident/Issue 04:36pm
Key issue
Fell from stage
Enter a brief description of the issue
The person had a serious slip and fell from the stage while moving portable stage pieces to erect
a drum riser.

Describe action taken

First aid given, ambulance called, made sure they were conscious.
2. Complete the following incident report form on a patron at a venue you are working
in as an usher. While ushering a patron who has been cut by broken glass left under
the seat from a previous performance. The cut is quite deep and will probably
require stitches.

Site Name
Super Bowl
Site Phone
0474850595
Site Manager James Jameson
Site Supervisor at
time James Jameson
Site Supervisors
Phone No
0394858500
Date of
Incident/Issue 23/06/20
Time of
Incident/Issue 07:30am
Key issue
Cut foot from broken glass
Enter a brief description of the issue
The person cut their foot from broken glass left from a previous performance

Describe action taken

Ambulance called, first aid given, person still responsive.
3. Complete the following hazard report. You are employed as a lighting technician with a
local theatre company and notice that a number of fixtures have frayed power leads.

HAZARD REPORT FORM

Name of person who identified the hazard

Bob bobson

Brief description of the hazard

Frayed power leads

Location of the hazard

Theatre

Date the hazard was identified

20/01/21

Assessment of risk posed by the hazard

Potential electrocution

Recommended action to control the hazard

Replace power leads

Signed Date

Charlie deane 31/05/23

WHSR signature Date