OCCUPATIONAL HEALTH & SAFETY POLICY by E7G8pPd

VIEWS: 8 PAGES: 17

									                  Occupational
                Health and Safety
                     Policy




Form I – 83/2                       Page 1
Occupational Health & Safety Policy
Clicks Recruit (Australia) Pty Ltd (“Clicks”) is committed to providing ongoing
awareness and standards of health and safety in the workplace for all of its employees
and contractors. As an employer and contractor, Clicks has a duty of care and statutory
responsibilities in regarding to safety within the workplace. Clicks objectives are to
prevent and reduce work-related injury or illness, promote healthy lifestyles and good
health, provide the safest possible workplaces for contractors and employees and
provide appropriate care for ill or injured employees.


Policy
1. Clicks recognises its obligation to provide a safe and healthy working environment.

2. Protective measures are to be taken as far as practicable to avoid injury to persons
   (general public, employees, contractors and service providers) and damage to Clicks
   property, to control hazards and to monitor and evaluate risks to health and safety.

3. Clicks will coordinate all efforts toward achieving risk minimisation and will provide
   leadership in this area.

4. Clicks will provide such information, instruction, training and supervision to its
   employees and contractors that will ensure that they can work in a manner that is
   safe to themselves and/or others.

5. All employees and contractors shall exercise individual initiative in identifying and
   eliminating unsafe work conditions and procedures and must immediately report to
   their supervisors and the health and safety contact at Clicks all potential risks,
   accidents, near misses and any issues of concern in a health and safety context.

6. Every employee and contractor is to ensure that his/her work is carried out safely
   and efficiently by following safe working practices, this Clicks policy, the policy at
   their workplace (if not Clicks) and safety instructions and rules. When safety related
   equipment (which includes ergonomic systems or equipment) or procedures are
   provided, they must be used. Safe working procedures must be followed at all times.

7. Employees and contractors must not negligently, deliberately or recklessly interfere
   with or misuse safety related equipment. They must not deliberately put at risk the
   health and safety of others.

8. Employees and contractors must not negligently, deliberately or recklessly interfere
   with or breach this policy or the safety policy and procedure at another workplace
   (unless inconsistent with the Clicks policy). Where the Clicks policy or procedure is
   inconsistent with the policy or procedure at another workplace, they immediately
   should contact their supervisor and the health and safety contact at Clicks to obtain
   direction.

9. Active and on going assessment and review of all operations and work procedures
   will be undertaken by Clicks to assess and minimise risk.

10. All clients of Clicks are aware of this policy and are aware of Clicks’ obligations to
    provide a healthy and safe workplace.



Form I – 83/2                                                                       Page 2
11. Clicks ensures that its clients maintain an occupational health and safety system and
    policy in the clients workplace that is consistent with the Clicks policy.

12. All work related injuries (including any injury at the workplace at which the employee
    or contractor works), near misses or health and safety concerns are reported and
    investigated to prevent re-occurrence and any employees or contractors injured at
    work are employees are encouraged and assisted to remain at work or return to work
    as soon as it is safely possible.

13. Clicks monitors and checks the workplaces of its clients to maintain the highest
    health and safety standards.




Form I – 83/2                                                                       Page 3
Procedure
Employees & Contractors


Clicks employees and contractors engaged to perform work on the premises of Clicks
clients as part of their assignment are required to comply with the occupational health
and safety policies and procedures of the client and to observe directions on health and
safety from designated officers of that organisation.

Failure to comply or observe a procedure, policy or direction in relation to health and
safety may be considered a breach of the employment contract or the contract between
Clicks and the contractor and may be sufficient grounds for termination of the contract
between Clicks and the employee or contractor.

Clicks employees and contractors engaged to perform work on the premises of Clicks
are required to comply with this policy and health and safety procedures of Clicks and to
observe directions on health and safety from the relevant officers of Clicks.

Where the Clicks policy or procedure is inconsistent with the policy or procedure at a
client’s workplace or another workplace, the employee or contractor immediately should
contact their supervisor and the health and safety contact at Clicks to obtain direction.

In order to avoid, eliminate or minimise hazards and ensure safety, the employee or
contractor will report all potential risk factors, health and safety related incidents, near
misses, concerns or questions (whether they involved the employee or contractor or
someone else at the workplace) to their supervisor and to the health and safety contact
as Clicks.

Each employee or contractor will ensure that he/she makes use of all safety equipment
or procedures provided for safety purposes.

Unless part of an approved maintenance or repair procedure, no employee or contractor
shall interfere with any safety equipment so as to render it ineffective.

Injured employees must make every reasonable effort to participate in an approved
rehabilitation or return to work program.

Contractors must maintain their own sickness or injury insurance.

Clicks

Clicks will achieve its occupational health, safety and welfare objectives by developing
and implementing policies and procedures which document standards and guide
employees contractors and clients in carrying out their responsibilities in:

   regular monitoring and audit of clients workplaces at which employees and
    contractors of Clicks work;

   identifying hazards and risks to health and safety associated with tasks and activities
    carried out by employees and contractors;




Form I – 83/2                                                                         Page 4
   selecting, implementing and maintaining appropriate measures to control risks to
    health and safety;

   developing and implementing a risk management and occupational rehabilitation
    program to prevent work related injuries and enable injured employees to remain at
    work or return to work as soon as it is safely possible.

   consulting with employees and contractors on matters which may affect their health
    and safety;

   identifying, developing and providing appropriate information, instruction and training
    to equip employees and contractors with the knowledge and skills necessary to meet
    their responsibilities;

   developing, implementing and monitoring plans to put Clicks’ health and safety
    policies and procedures into effect.

Clients

Clicks will ensure that –

   clients have adequate health and safety policies;

   clients have safe workplaces;

   inconsistencies between the Clicks health and safety policies and the client health
    and safety policies are resolved as soon as possible;

   contracts with Clicks regarding occupational health and safety standards are
    adequately specified;

   employees and contractors know who to report health and safety issues to;

   it regularly checks, monitors and audits client workplaces.




Form I – 83/2                                                                         Page 5
Roles and Responsibilities
Responsible Officer

The health and safety contact of Clicks is the responsible officer of Clicks for occupational
health and safety issues and has the overall responsibility to provide a healthy and safe
workplace for employees, contractors, services provides and the general public.

Clicks will ensure adequate resources are provided to meet the health and safety
objectives and implement strategies.

In particular, the health and safety contact will ensure:

   occupational health and safety performance is an integral component of Clicks
    business and financial plans;

   annual health and safety strategic plans are developed and implemented to meet
    health and safety objectives;

   appropriate health and safety policies and procedures are developed and
    implemented to enable the effective management of health and safety and control of
    risks to health and safety;

   employees, contractors and consultants are consulted on any proposals for, or
    changes to the workplace, work practices, policies or procedures which may affect
    their occupational health, safety and welfare;

   Clicks employees and contractors receive training in the necessary knowledge and
    skills in order that they can carry out their health and safety responsibilities;

   occupational rehabilitation and return to work programs are developed and
    implemented;

   Clicks employees and contractors are monitored and assessed on their health and
    safety performance;

   clients workplaces are checked, monitored and audited;

   clients are monitored and assessed on their health and safety performance.

Supervisors and Consultants of Clicks

Supervisors and consultants of Clicks have a responsibility to:

   carry out their roles and responsibilities as detailed in the relevant health and safety
    policies and procedures;

   ensure relevant health and safety policies and procedures are effectively
    implemented by contractors, employees and clients;

   engage fully qualified workplace assessors, where necessary, to inspect, assess and
    monitor every Client's workplace.




Form I – 83/2                                                                           Page 6
   ensure that contractors and employees are only placed in client workplaces which
    pass workplace assessment;

   encourage contractors and employees to report all symptoms of work related injury,
    disease and near misses;

   investigate and document all workplace accidents, injuries, diseases or near misses
    reported by contractors employees and take risk control measures to prevent re-
    occurrence of such risks to health and safety;

   implement the occupational rehabilitation program if an employee under their control
    is injured at work.

   consult with the injured employee to establish and implement a return to work plan.

   provide the contractors and employees under their control with the necessary
    information, instruction and training to effectively and safely carry out their jobs.

   consult contractors, employees and clients on any proposals for, or changes to the
    workplace, work practices policies or procedures which may affect their health and
    safety.

Contractors & Employees

Contractors and employees have a responsibility to take care to protect their own health
and safety and to avoid adversely affecting the health and safety of any other person.

Contractors and employees have a responsibility to:

   report any incident, hazards or near misses at work to their supervisor at the Client's
    workplace and to Clicks as soon as possible;

   carry out their roles and responsibilities as detailed in the relevant health and safety
    policies and procedures of Clicks and the Client;

   obey all reasonable instructions aimed at protecting their health and safety while at
    work;

   co-operate with health and safety representatives of the Client;

   use any equipment provided to protect their health and safety while at work;

   assist in the identification of hazards, the assessment or risks and the implementation
    of risk control measures;

   provide feedback on any matter which may affect their health and safety;

   if injury occurs at work, report, as soon as possible, to Clicks

   comply with the procedure contained in this policy as it applies to employees or
    contractors or both.




Form I – 83/2                                                                               Page 7
Clients

As part of Clicks commitment to the proper management of occupational health and
safety, Clicks requires all Clients to provide a healthy and safe workplace for contractors
and employees.

Clients have a responsibility to:

   comply with all relevant laws and codes of practice relating to occupational health and
    safety;
   cooperate with any inspections and reviews of their workplace by an independent
    workplace assessor;
   comply with all Clicks policies and procedures relating to occupational health and
    safety and any recommendations made by an independent workplace assessor;
   ensure all risk control measures are implemented, regularly monitored and
    maintained;
   ensure all contractors or employees of Clicks under their control are provided with the
    necessary information, training, instruction and supervision to effectively and safely
    carry out their jobs;
   investigate any workplace injuries, diseases or near misses involving contractors or
    employees and take risk control measures to prevent re-occurrence of such incidents;
   report all health and safety workplace incidents to Clicks as soon as possible;
   cooperate with Clicks to implement the occupational rehabilitation program if a
    employee is injured in the client's workplace;
   assist an injured employee to remain at work or return to work as soon as it is safely
    possible;
   allow Clicks to check, monitors and audits client workplaces at all reasonable times.

Health and Safety Representatives

Clicks will encourage and facilitate the formation of work groups of employees and the
election of health and safety representatives to represent employees on health and safety
matters.

The role of health and safety representatives is to:

   represent employees from their designated work group on health and safety matters;

   investigate health and safety related complaints prior to representations to
    management;

   make representations to management and report back to employees on any matter
    relating to health and safety;

   discuss with the employees any proposals or matters which may affect the health and
    safety of employees;

   assist management in the identification of hazards, the assessment or risks and
    implementation of risk control measures;

   assist in promoting adherence to health and safety policies and procedures;

   assist in the monitoring of risk controls and health and safety policies.




Form I – 83/2                                                                         Page 8
Health and Safety Committee

Clicks will establish a Health and Safety Committee for a workplace consisting of
management and employee representatives if there are a minimum of 20 employees per
workplace and a specific request is made by the appropriate number of employees. The
Health and Safety Committee together with any Health and Safety Representative will be
the principal forum for management to consult with employees on all health and safety
and welfare and policies issues.

The responsibilities of the Committee are to:

   assist in the development, monitoring and review of health and safety policies and
    procedures;

   consider any proposal for, or changes to the workplace, policies, work practices or
    procedures which may affect the health and safety of employees;

   promote the importance of health and safety amongst management and employees;

   monitor Clicks health and safety performance;

   monitor the rehabilitation of injured employees;

   assist in the resolution of health and safety disputes.

Review of Policy

The health and safety policy will be reviewed regularly in consultation with employees,
the Health and Safety Representative and the Health and Safety Committee.

The review will involve assessing the effectiveness of the policy and program by such
means as:

   reviewing overall health and safety performance;

   monitoring the effectiveness of policies and procedures.

Dissemination of Policy

As part of each employee and contractor induction, they will be provided with a copy of
this policy. Contractors and employees will have ready access to all health and safety
policies and procedures both of Clicks and the relevant client through their supervisor or
consultant and the Health and Safety Representatives.




Form I – 83/2                                                                       Page 9
Safety Induction
At Clicks we are committed to ensuring our employees and contractors enjoy a safe and
healthy work environment. We have adopted a planned and systematic approach to the
management of occupational health and safety.

As an employee or contractor you have a responsibility to take care and protect your own
health and safety. The following pages set out basic requirements you must follow to
protect your health and safety, which are relevant to your job requirements.

These requirements are the minimum requirements.

Your employment or contract with Clicks may place you in all types of workplaces, some
of which are more dangerous than others or have specific safety issues.

If you are working with hazardous machinery, hazardous substances or manual handling,
you must take further precautions to protect yourself and you will be informed about
specific health and safety aspects of that part of your job.

At all times, if you are unsure, contact your Clicks consultant or health and safety
contact and discuss your concerns.

Computer Use and Office Work

Contractors and employees must follow the guidelines contained in the documents titled
“Officewise” A Guide to Health and Safety in the Office produced by WorkSafe
Victoria and which can be accessed on the WorkSafe website www.workcover.vic.gov.au.
Clicks and your health and safety contact will be aware of this document and can provide
further information and training relevant to your position. If an employee or contractor is
unsure about any part of the Guide, they should discuss it with their supervisor and health
and safety contact.

       Become familiar with each client's workplace and safety procedures, especially
       emergency procedures and First Aid. Make safety a priority in your work
       environment.


        At ALL times at work, you must:
         Ensure your safety and the safety of your co-workers.
         Report all accidents, injuries, near accidents and unsafe conditions to your
         immediate supervisor and/or Clicks Consultant, and get prompt first aid for all
         injuries no matter how minor.
         If you are injured at work, notify your immediate supervisor and/or Clicks
         Consultant immediately and before recommencing work. Workers
         compensation may not be recovered if you have not notified your immediate
         supervisor and/or Clicks Consultant of the injury. An accident report must be
         completed.


        If your job description involves lifting, protect your back. Think before you lift and
         remember to lift from the knees with a straight back.




Form I – 83/2                                                                          Page 10
        Be sure to properly adjust your workstation before commencing work. Your chair
         should be adjusted so that your knees are at 90 degrees to the chair when seated,
         ensuring your lower back is properly supported


        Your monitor should be directly in front of you. Documents should be placed so
         as to minimise head movement


        Your mouse should be to the immediate left or right of the keyboard


        Take regular “stretch” breaks


        Mobile phones are to be turned off during work hours. Please keep personal calls
         to an absolute minimum.


Basic Back Protection

Your back is the only one you have and it must be properly cared for, one injury can be
for life. Do not take chances. Your back must be kept straight at all times and all lifting
should be done through the legs. By following the next seven (7) steps you will reduce
the risk of a back injury.

        Plan your lift, it is essential to assess the weight and load size first. Should you be by
         yourself or as part of a team, or does the load require a mechanical device to perform
         the lifting?
        Check for obstructions where you intend to take the load making sure that pathways,
         as well as the intended destination are clear.
        Always check for the load for sharp edges or a slippery surface before attempting a
         lift.
        Check your body position, if lifting from a low position make sure your legs are bent, if
         lifting from a mid height your knees should still be bent, with your feet hip width apart
         and above all your back must be straight.
        You must keep the load close to your body when lifting, remember your back is not a
         crane.
        When turning while carrying a load you must turn with your feet and not your back,
         never twist, always walk the curve.
        Finally, many people get it right when lifting and forget that the same injuries can
         occur when putting the load down, keep your back straight, bend your knees and
         keep the load close to your body at all times.

Basic Eye Protection

Like your back an eye injury can be for life. Why risk it? You need Safety Glasses if you
are operating any Metal or Wood working Machinery, Power Tools or handling Explosives
and Chemicals. Indeed any environment where foreign matter is or could be airborne is
an environment that requires Safety Glasses. Even if you wear eyeglasses or contact
lenses these do not protect your eyes and will require fitting with side protector’s etc., or
recognised Safety Glasses worn over the eyeglasses.




Form I – 83/2                                                                          Page 11
Should you sustain an injury or foreign body in your eye do not rub, as this will often
increase the injury. Notify your supervisor and health and safety contact and seek
assistance from a first aid officer immediately.

If you are using any of the previously discussed items ensure you know how to react
should you receive an eye injury, for example in the case of Chemicals read the label, it
will explain the best way to treat any contamination, often commonly stated is the advise
“rinse under water”. In addition if you are exposed to an environment of strong light of for
example welding flashes you must either have protective screens or the appropriate
Safety Glasses which will shield the burning effects of the flashes.

Basic Hearing Protection

Hearing damage is likely to occur over a number of years without any perceptive change.
In the true sense it will sneak up quietly, or in other words the quite will sneak up on you.
If you are using any power tools, petrol driven equipment or process machinery you need
hearing protection. Indeed if the level of background noise or other is sufficient to cause
you to raise your voice in order to be heard you need hearing protection.

Basic Lung Care

Taking care of your lungs must be considered on every assignment. For every instance
of a visible need to wear protective masks there is usually the instance of an invisible
need. Always be aware of any substance you are using or the environment you are
placed in. Just because others may not be wearing protection does not mean protection
is not required.

Other Personal Protective Equipment (P.P.E.)

There is Personal Protective Equipment (PPE) available for every part of your body and
for every type of hazardous work. The environment in which you are working will dictate
what level and amount of P.P.E. is required. Unfortunately some organisations still do
not believe in supplying adequate levels of P.P.E. or adequate quantities as required,
instead trying to stretch out supplies. Should you find yourself in this situation it is your
responsibility to ensure you have the correct P.P.E. or replacement of expired equipment.
The requirement for equipment such as gloves, safety glasses, hearing plugs, steelcap
boots, hard hats and clothing are usually self-evident or at the least sign posted.
However the requirements for special equipment such as particular breathing mask or
grade of gloves may not be, this is common when using Chemicals. If there is any doubt
ask to read the product specifications which will detail the correct P.P.E. to use.


Workplace Bullying & Violence

It is everyone’s responsibility to ensure that workplace bullying and violence does not
occur in the workplace.

The following definitions are provided by WorkSafe –

Workplace bullying is defined as repeated, unreasonable behaviour directed toward an
employee, or group of employees, that creates a risk to health and safety. The following types
of behaviour, where repeated or occurring as part of a pattern of behaviour, could be considered
bullying:
     verbal abuse



Form I – 83/2                                                                         Page 12
        excluding or isolating employees
        psychological harassment
        intimidation
        assigning meaningless tasks unrelated to the job
        giving employees impossible assignments
        deliberately changed work rosters to inconvenience particular employees
        deliberately withholding information vital for effective work performance

This list is not exhaustive. Other types of behaviour may also constitute bullying.

Occupational violence is defined as any incident where an employee is physically attacked or
threatened in the workplace. It is defined as any incident where an employee is physically
attacked or threatened in the workplace. The term applies to all forms of physical attacks on
employees including:
     striking, kicking, scratching, biting, spitting or any other type of direct physical contact
     attacking with knives, guns, clubs or any other type of weapon
     pushing, shoving, tripping, grabbing
     any form of indecent physical contact


Be Aware of Hazards

Hazards in the workplace come in all forms imaginable and then more, often they creep
up unseen, and become accepted hazards with everybody going about their business
until an injury occurs. A Clicks Consultant will not deliberately send you to a hazardous
workplace. As a Clicks Temporary Employee you should constantly assess your
workplace. If you believe a site is hazardous you must inform your Clicks Consultant. On
first entering a workplace, ask:

   where are the safest exits?;
   where are the assembly points?;
   what are the areas to avoid such as stockpiles of Chemicals, Flammable Goods etc?.

A common form of hazard is the blocking of fire extinguishers or pathways and exits with
goods or equipment such as forklifts. Further hazards will be discussed with
housekeeping, safety signs, guards, lockout tags and driving on a site.


What is Housekeeping?

A site that practices good housekeeping will usually have a low incident of injuries, while
poor Housekeeping often attracts a high record of injuries. Housekeeping is the practice
of keeping the workplace tidy and free from the placement of items, which may cause a
hazard. Common practice include placing litter in bins, keeping floors free from items or
substances which could be tripped over or slipped on, keeping access areas such as
stairs clear form extension cords, returning equipment and material to the correct storage
as soon as possible.




Form I – 83/2                                                                          Page 13
Correct Housekeeping is practised before, during and after a task is
completed.

An example of bad Housekeeping will be items from a previous task left flying around on
a bench or on the floor.

Why do Safety Signs Exist?

Safety signs exist to advise conditions of danger (caution), mandatory (you must do) or
prohibitory (you must not do) and must be followed without exception. Sometimes a
safety sign may seem unnecessary, however the placement of a safety sign has often
been precipitated by an injury.

The three main safety signs you will encounter are:

Black and Yellow, which means Caution eg: Low Beam or Slippery when Wet, etc.
Blue and White, which means Mandatory eg: Safety Glasses must be worn in this area,
etc.
Red and White which means Prohibitory eg: No Smoking in this area, Do Not Enter, etc.

Why does this Switch have a Lockout Tag?

Lockout tags signify that someone is working on a machine or that the machine is faulty
and not operational and are in all cases placed on the operating or isolating switch of the
machine. Under no circumstances can a machine be operated when a lockout tag has
been placed, should the machine be operated then the person working on the machine
could be injured, or worse killed. A lockout tag can only be removed by the person who
placed it on the switch. The golden rule to follow is do not operate any machine that has
a tag on the switch no matter what the colour, shape or size.

Why do Machines have Guards?

Guards take many different forms from wire mesh to fully sheeted enclosures, they do
however serve only one purpose, To stop you from being caught in a machine and
injured. Under no circumstances can a machine be operated if a guard has been
removed, is faulty or has been tampered with. A machine correctly fitted with a guard will
not operate should the guard be removed. Unfortunately as with P.P.E. some
organisations will operate machines without correct guards or indeed with the guards
removed. Do not take chances if you are operating a machine without a guard or suspect
tampering contact your Clicks Consultant immediately.

Driving a Vehicle on a Site and Parking

Driving a vehicle on a site and parking on site is a privilege and not a right. You must
obey all speed signs and normal driving standards, in addition beware of traffic or
machinery emerging from around a corner. In the absence of signs (10) ten kmph is the
standard maximum speed allowed on a site. Parking is always an issue and if you have
any doubt whether you have parked in the correct area ask your supervisor, do not park
in front of an office unless directed to do so as in most cases there will be a staff car park
available.




Form I – 83/2                                                                          Page 14
Evacuation

 Leaving the area as safely as possible
 Moving through the safest exit

In the case of an evacuation being called you must leave the area you are working in as
safe as possible. This means turning off any machinery or equipment you are using and
making sure access ways are clear. In an evacuation you are not the only person
required to leave the area and often the area you have been working in may be the route
travelled by others to an exit. Once your area is safe for others to move through proceed
to the safest exit, this often is not the closest exit. As discussed in hazards you should
know where any stores of hazardous materials are and which is the safest exit for you to
go through. You should then continue to the nearest assembly point, which is commonly
in or beside the car park.

Be Fire Aware and How to Respond

Be fire aware, know where the extinguishers are and what type of extinguisher to use. If
you have practised good Housekeeping you will not have a high risk of a fire in your area.
If you do have a small fire do not panic, use the appropriate extinguisher and raise the
alarm immediately. If there is a large fire, do not panic, all organisations are required to
have a fire policy and action plan to deal with a fire. Leave the response to the team that
is trained on site. Leave your area as safe as possible and move through the safest exit
to the assembly point. Above all do not be a hero, if you are caught inside as a casual
you may not be on a role call.


Medical Treatment Procedure
At Clicks we take the health and well being of our people seriously and have therefore
put in place a list of preferred practitioners for you to see should the need ever arise. If
you are in need of some medical treatment whilst at work, please advise your supervisor
and the health and safety contact of Clicks.

Your supervisor or Clicks health and safety contact will help you with medical needs
should you require.


Incident Report Form
All incidents relating to workplace health and safety including injury, illness, perceived risk,
near misses, concerns, suggestions for improvements must be reported to your
supervisor, the client (if applicable) and the health and safety contact of Clicks via
following form –




Form I – 83/2                                                                          Page 15
OH&S Report Form
This is a report for:            Accident    Incident      Near Miss  Comment 

Personal Details

Surname: _____________________ First Names: _____________________________

Address: _________________________________________________________________

Contractor or Employee?: ________________________________

Sex:            Male    Female         Date of Birth:    _____________________________

Phone Number: ___________________ _____________________________________ or


Client Details (if applicable)

Client Name: _______________________________________________________________

Client Address: ____________________________________________________________


Phone Number: ________________ Supervisor’s Name __________________________


Details of Report

Date injury or incident Occurred:      ____________________________________________

Time injury or incident occurred: _____________________________________________

Date Reported: _______________________ Did you cease work?                  Yes         No 

Date you ceased work: _________________________________ Time: ___________

Have you returned to work? ________________               If so at what time?: _____________

Name of witness: ___________________ Where did it occur?: ___________________

Incident Summary (What, How, Where did the injury or incident happen?) ___________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________




Form I – 83/2                                                                       Page 16
Details of Injury or risk: _____________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________


What type of injury did or could have been suffered?: ____________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________


Treatment
First aid        By Whom?: __________________________________________________
Doctor Visit
Hospital Visit


What action has been taken/should be taken to Prevent a Recurrence: _____________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________


Did you record the injury or incident in the clients records?       Yes        No




Signed______________________________




Form I – 83/2                                                             Page 17

								
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