Safety and Wellbeing Reporting

Report Injury

Have you seen or been involved in an incident that has caused injury to a person.

Report Illness

Have you seen or been involved in an incident that has resulted in someone becoming ill or unwell.

Report Incident

Have you seen or been involved in an incident which could have caused harm to a person, or has caused damage to property / environment.

Report Near Miss

Have you seen or been involved in an event that had the potential to cause an injury or an incident.

Feedback

Give Feedback to the Safety and Wellbeing Team.
Please do not use this form to report incidents or near misses

Instructions: Please complete all fields with as much relevant detail as possible. Once completed, 'Save' the form and the following events will occur:
• You will be given a reference number, save or write this number down for future reference
• An email will be sent to the supervisor of the person involved in the incident

Ailment Details

The Primary Injury is the most important / critical injury to the person.
Primary Body Location Body Area Injury

Feedback

Instructions: Please complete all fields with as much relevant detail as possible. Once completed, 'Save' the form and the following events will occur:
• You will be given a reference number, save or write this number down for future reference
• An email will be sent to your supervisor advising a form has been submitted