Please record all health and safety incidents as soon as possible.
Travel incident related to business travel are also to be recorded on this form.
Ensure the responsible Navitas Manager has been verbally notified of the incident.
If you do not have all the necessary information, please complete the form with the available information, additional information can be added later.
Select the option that best describe the party involved.
Please enter the name of the person involved in the incident. If this was property damage, please enter "not applicable".
Select the incident type that best describes the event.
The bodily location of the most serious original injury or part of the body affected by disease
If you chose “Other†above, please fill in details below
What was the classification that best described the type of injury/illness sustained by the person?
What was the direct cause of the injury sustained and what particular process, equipment or chemical, was
involved?
Please select the most appropriate illness category
Select one
What was the direct cause of the property damage and what particular process, equipment or chemical, was involved?
Has the Landlord/property owner been advised of the Property Damage?
What was the potential cause of the incident and what particular process, equipment or chemical, was involved?
Location within the site where the incident occured
Select the type of emergency event
This item refers to location-wide emergencies that require the activation of the alarm systems, emergency services calls or for the whole location involving everyone (or the majority of staff) at the location.
Type of alarm was appropriate
Were the instructions issued by wardens followed or not
There were enough wardens to cover the requirements of the emergency
Were the wardens easily and quickly identifiable and were they clear in their communications
If your response has been "No" to any of the above please fill this in.
If your response has been "Yes", but you feel something can be improved please fill in this section
Please outline any steps taken to resolve the incident. If none taken please enter "none".
Provide most applicable further actions to be taken
Briefly outline why the manager has not been not been notified.
If there were witnesses please supply details below