<p> COMPLETING THE CONFIDENTIAL INCIDENT / INJURY / NEAR MISS REPORT FORM</p><p>Reporting of incidents, injuries, hazards and near misses is a legal requirement of employees under the Occupational Safety and Health Act 1984. This document specifies the responsible parties, their obligations and the various reporting methods.</p><p>Contacts: Safety and Health 6488 3938; Technical Officer (Electrical) 6488 2031; FM Jobs 6488 2025</p><p>Incident, Injury, Near Miss</p><p>For all incidents, injuries and near For all needlestick / sharps For All misses (except needlestick / All electrical injuries or exposure to body hazards use sharps incidents or exposure to fluid use the the body fluid) use the incidents Confidential Incident / Confidential Needlestick Hazard Injury / Near Miss Report Sharps Injury or Exposure Report Form Form to Body Fluid Report Form Contact FM Jobs, Complete Part 1 within Also report to the if required. 24 hours and send to Technical Officer Safety and Health. (Electrical) Immediately</p><p>STAFF STUDENT CONTRACTOR VISITOR</p><p>Notify immediately: Report to Report to Project Complete the report School or Leader or Manager Supervisor form and inform Centre Manager UWA contact or Management Safety & Health Rep liaison person. Report form to be sent to UWA Safety and Health</p><p>Completing the Confidential Incident / Injury / Near Miss Report Form Published: June 2012 Version 1.3 Authorised by: Safety and Health Review: June 2017 Page 1 of 3 Uncontrolled when printed. The current version is available on the Safety and Health website Please use this checklist to verify completion of the reporting and investigative process:</p><p>Part 1: Must be completed within 24 hours but if serious, the incident must be reported immediately to Safety and Health. Section A:  Injured Person’s Details – all details must be completed.  Incident Details – all questions must be answered. Section B:  Signed by Safety and Health Representative  Signed by Supervisor/Manager Section C:  To be completed if injury sustained.</p><p>Part 2: To be completed and forwarded to Safety and Health within 5 working days. For information on investigations, see www.safety.uwa.edu.au/policy/investigation or contact Safety and Health. If completing the form on behalf of another person you are identified as the Agent. Section 1:  Person involved in incident  Answered relevant questions relating to Slip/Trip/Fall, Manual Tasks, etc  Investigation questions answered Section 2:  Risk Control Table (preventative actions) and Timeline completed  Feedback provided to person reporting incident/injury  Signed by Supervisor/Manager  Signed by Head of School/School Manager – Dean informed  Signed by Safety and Health Representative</p><p>Resources</p><p>Investigation Guidance: If you require information on investigations contact Safety and Health, or see WorkSafe’s investigation bulletin for guidance; http://www.commerce.wa.gov.au/WorkSafe/PDF/Bulletins/Bulletin_02_2007.pdf </p><p>Safety and Health Representative: You must contact your Safety and Health Representative, if there is one in your area, immediately following the incident. To find your Safety and Health Representative see http://www.safety.uwa.edu.au/people/safety_and_health_representatives</p><p>Needlesticks/Sharps Injuries or Exposure to Body Fluid Incident: The Incident/Injury Report Form is to be used with the exception of Needlesticks/Sharps Injuries or Exposure to Body Fluid Incidents for which there is a specific alternative form. http://www.safety.uwa.edu.au/forms/needlestick_form </p><p>Facilities Management Jobs: For minor maintenance jobs contact Facilities Management Jobs. http://www.fm.uwa.edu.au/for/uwa_staff/maintenancechargeable_job_requests2 Completing the Confidential Incident / Injury / Near Miss Report Form Published: June 2012 Version 1.3 Authorised by: Safety and Health Review: June 2017 Page 2 of 3 Uncontrolled when printed. The current version is available on the Safety and Health website Completing the Confidential Incident / Injury / Near Miss Report Form Published: June 2012 Version 1.3 Authorised by: Safety and Health Review: June 2017 Page 3 of 3 Uncontrolled when printed. The current version is available on the Safety and Health website</p>