INCIDENT & HAZARD REPORT —

About this tool: Use this form to record workplace incidents, near misses, hazards, and dangerous occurrences. Under the Work Health and Safety Act 2011, PCBUs must record and investigate work-related incidents and consult with workers on corrective actions.

Select a report type below, complete the relevant fields, optionally upload site photos, then click "Generate Report". The AI will produce investigation findings and corrective action recommendations based on the details you provide. Each report costs 1 credit.

🚨 If someone has been seriously injured or a dangerous occurrence has happened — call 000 first if emergency services are needed. Notifiable incidents must be reported to your state/territory WHS regulator immediately. Do not disturb the incident site without regulator approval.

Supervisor:

Ph:

Email:

Company/Business Name:

Person Responsible — Report Review:

Date for Review:

Address / Site Location:

Date of Report:

Report Number:

📷 Evidence Photos — Optional AI Analysis

Upload photos of the incident scene, hazard, or damaged equipment. Photo upload is optional.

🖼️Upload Photo

📷Take Photo

Select Report Type

Select the type of incident or hazard you are reporting. Relevant fields will appear below.

Scroll right to see all types →

✅ Selected: None selected

⚠️ Near Miss Report

Date of Near Miss:

Time:

Specific Location:

Person(s) Involved:

What Happened — Describe the Near Miss Event:

Immediate Cause:

Underlying / Root Cause:

Witnesses:

🩺 Work-Related Injury / Illness

🚨

Possible Notifiable Incident

If this injury involves a death, a serious injury or illness (requiring immediate hospital treatment, amputation, serious head/eye/burn injury, etc.) or a dangerous occurrence, you are legally required to notify your state/territory WHS regulator immediately. Do not disturb the incident site without regulator approval. See Safe Work Australia — Notifiable Incidents.

Injured Person's Name:

Role / Trade:

Date & Time of Incident:

Location on Site:

Nature of Injury / Illness:

Body Part Affected:

Treatment Provided:

Estimated Time Off Work:

Witnesses:

How Did the Incident Occur?

🏚️ Property Damage Report

Date & Time of Damage:

Location on Site:

Item / Property Damaged:

Description of Damage:

Estimated Repair / Replacement Cost:

Witnesses:

Cause of Damage:

🌿 Environmental Incident Report

Date & Time of Incident:

Incident Type:

Substances / Materials Involved:

Estimated Volume / Quantity:

Area / Environment Affected:

Immediate Containment Actions Taken:

Environmental Regulator / EPA Notified?

Regulator Reference No.:

🔒 Security Incident Report

Date & Time of Incident:

Incident Type:

Location:

Person(s) Involved:

Description of Incident:

Items Stolen / Damaged (if applicable):

Police Event / Report Number: Police Notified?

Witnesses:

🔍 Hazard Identification

Date & Time Hazard Identified:

Specific Location:

Hazard Identified By:

Hazard Type:

Describe the Hazard:

Risk Rating:

Low Medium High Extreme

Immediate Action Taken:

Persons at Risk:

🚨 Dangerous Occurrence — Notifiable Incident

🚨

Mandatory Reporting Required — Stop Work if Unsafe

A Dangerous Occurrence is a notifiable incident under the Work Health and Safety Act 2011. You must immediately notify your state/territory WHS regulator by phone. Do not disturb the site until authorised. Examples: collapse of a structure or scaffold, uncontrolled explosion or fire, failure of a pressurised vessel, electrical incident causing injury, collapse of a trench or excavation. See Safe Work Australia — Notifiable Incidents.

Date & Time of Occurrence:

Type of Dangerous Occurrence:

Description of the Dangerous Occurrence:

Persons Exposed / At Risk:

Injuries / Deaths (if any):

Immediate Actions Taken:

WHS Regulator Notified?

Regulator Reference / Notification No.:

📋 Investigation Findings & Recommendations

Scroll down to see full report ↓

✅ Corrective Actions Register

Record the corrective actions to be taken as a result of this incident. Assign responsibility and set target completion dates.

#	Corrective Action Required	Person Responsible	Target Date	Status

Authorisation & Sign-Off

Role	Printed Name	Signature	Date
Investigating Supervisor
Site Manager / Director
WHS Representative

Record Keeping: This incident report and all corrective action records must be retained for a minimum of 5 years under the Work Health and Safety Regulation 2017. If this was a notifiable incident, the record must be kept for 5 years from the date of notification to the WHS regulator. These records may be requested by a WHS inspector at any time.