Incident Report Procedure & Form - ASC HSE 004 & 005

Controlled Document: ASC HSE 005

Status: Active

Reviewed: 12th June 2025

Title: Incident Report Procedure

Approved By: Dilan Rajapaksha

Version #: 3

Purpose

To ensure all workplace incidents, injuries, near misses, and hazards are reported, documented, and investigated in line with WHS Act 2011 (Australia) and HSWA 2015 (New Zealand).

Scope

Applies to all ASC staff, subcontractors, and site visitors across Australia and New Zealand.

Responsibilities

  • All Staff must report any incident immediately.
  • Supervisors must ensure forms are completed and submitted.
  • Operations Manager oversees investigation and documentation.
  • HSE Coordinator ensures compliance and follow-up actions.

Reporting Requirements

  • All incidents must be reported within 12 hours to the ASC Operations Manager.
  • Notifiable incidents (e.g. serious injury, hospitalisation, death) must be reported to:
    • Safe Work Australia / WHS Authority (AU)
    • WorkSafe New Zealand (NZ)
  • If medical treatment is required, attach photos and complete ASC HSE 004 form on-site.

Incident Response Procedure

  1. Ensure Safety
    • Stop work, control the hazard, provide first aid.
    • Make the area safe before proceeding.
  2. Notify Supervisor or Site Manager
    • Immediate verbal notification is required.
  3. Complete Incident Report (ASC HSE 004)
    • Must be completed before the injured party leaves site (unless medically urgent).
    • Attach photos and witness details.
    • Submit to Operations Manager.
  4. Escalation & Investigation
    • The HSE Coordinator or designated investigator will contact relevant parties.
    • Root cause, corrective action, and recommendations will be documented.
  5. Preventative Action
    • Follow-up action plan will be recorded and monitored for close-out.

Contact for Support:

ASC247 — 0451 512 537

Email — helpdesk@asc247.com.au

Portal — asc247.com.au

⛑ Compliance

This form satisfies reporting obligations under:

  • WHS Regulation 699–702 (Australia)

  • Health and Safety at Work (Notifiable Events) Regulations 2016 (NZ)

Call 1300 272 247


Site Details

Site Name *


Location *


Incident Timeline

Date & Time of Incident: *


Personnel Involved

Personnel Involved | Supervisor: __________ Assistant/Driver: __________ Contractors On-Site: __________ *


Witnesses:


Injury Details

Injured Person(s): *


Injured Person(s): *


First Aid Given by: *


Medical Treatment Required *


Attach Photos: *


Click here to download file

Equipment Damage

Equipment Name:


Description of Damage:


Action Taken


Incident Description

Incident Description - Describe clearly what happened: *


What was the primary cause of this incident? *


Management Use Only

Preventative Actions


Action
ResponsibleDue DateStatus (Open/Closed)


Supervisor Name


Sign


Date


Operations Manager Name


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Date


HSE Coordinator Name


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Date


Director Name

Role                 Name                        Signature                          Date
Director
Supervisor
Operations Manager
HSE Coordinator

Sign


Date