Incident flash report checklist
Vs-hs-frm-047 issue 1
What does this form include?
This form contains 14 sections:
Description of the Incident:
Location:
Name/s of persons involved:
Staff dealing with incident:
Staff attending incident site:
Responsible Supervisor/Manager:
Provide details of any corrective action taken at the time of this report:
Incident Type
- Safety and Health
- Environment
- Community
- Non-SHE
- Fatality/s
- Lost Time Injury / Taken to Hospital
- Medical Treatment Injury
- First Aid Injury
- Near Miss
- Property Damage
- Security Breach
- Hazard
- Procedural Breach
- Other
Other description
Drug and Alcohol Testing
- Drug and alcohol testing undertaken?
Incident Classification
- Class 1
- Level 1
- Class 2
- Level 2
- EPC1
- PC1
Name
Signature
Phone number
Use this template