Accident and Hazard Report

Use this form to report any OHS and Environmental related workplace accident, injury, illness, near miss, incident, dangerous occurance or hazard. A separate Workers Compensation Claim Form is required if compensation is sought. Please contact the HWS (OHS) unit: for Geelong/Warrnambool: 72869, Melbourne 68175.

Privacy: The information collected on this form will be used to investigate the incident, respond to you, discuss with your manager, address health and safety issues, collate statistics and to inform the University‚Äôs insurer. Information from the form may be provided to other areas of the University such as the Risk Management Unit, Facilities Management Services Division or Campus Services
to address hazard or risk issues. The submitted form is accessible by the staff of the HWS unit in Human Resources Division and those to whom they report. If you wish to keep information in your report confidential, please use the standard hand-written accident report (48KB) form or ring the HWS Unit before submitting the form. You have a right to gain access to your personal information held by the University. Requests for access are managed under the Freedom of Information Act 1982.

If you do not wish to use this form, the standard hand-written accident report (48KB) form can still be used.

Details of the person involved in the accident or reporting the hazard
Birthdate

     

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