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Search job
Employers
Jobseekers
Why us
Reviews
Tools
Tech smackdown
Employment legislation & law
Hive blogs
Fee structure
Contractor & Client rates
HR documents
About
Blog
Contact
Contractors
Payroll Operations
Your Benefits
Banked Pay
Payroll Operations Terms of Service
Incident Notification Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Person Completing this Form
Name
*
First
Last
Phone
*
Email
*
Position Title
*
Type of Report
*
--- Select Choice ---
Hazard
Near Miss
Incident
Safety Breach
Other (Please Specify)
Please Specify the Type of Report
*
Type of Incident
*
--- Select Choice ---
Physical
Psychosocial
Environmental
Other (Please Specify)
Please Specify the Type of Incident
*
Was anyone affected by the incident?
*
Yes
No
Person Affected
Title
Mr
Mrs
Ms
Dr
Mx
No Title
Name
*
First
Last
Date of Birth
Gender
Male
Female
Non-binary
Prefer not to say
Address
Address Line 1
City
State / Province / Region
Postal Code
Preferred Contact Number
Preferred Email Address
of the Incident
Name of Employer
*
Host Organisation (if applicable)
Main Duties
Position Title
Employment Type
Employee (Recruitment Hive Office)
Employee (PAYG)
PTY Contractor
Other (Please Specify)
Please Specify the Employment Type
*
Was the affected person injured?
*
Yes
No
About the injury
Where is the injury (select all that apply)
Torso (other than back)
Shoulder/arms
Elbow
Hip/Leg
Knee
Hand/Fingers
Foot/Toes
Eye
Back
Neck
Head/Face
Internal organ
Psychological
Other (Please Specify)
Please specify the location of the injury
*
Type of Injury (select all that apply)
Cut/laceration
Bruise
Puncture
Sprain
Strain
Fracture/Break
Foreign Object
Crush
Twist
Burn
Other (Please Specify)
Please specify the type of injury
*
Mechanism of the Injury
*
--- Select Choice ---
Slip | Trip | Fall
Hit by moving object
Sound/pressure
Body Stress
Heat | Electricity | Environment
Chemical | Dangerous Substance
Biological
Mental Stress
Other (Please Specify)
Please specify the mechanism of the injury
*
About the incident
When did it occur?
*
Date
Time
Where did it occur?
*
Address Line 1
City
State / Province / Region
Exact Location: (i.e. kitchen, stairs, boardroom, office, coffee shop)
*
Did the incident involve any of the below: (select all that apply)
*
Violence/Abuse
Bullying and/or harassment
Discrimination
Illegal action/behaviour
None of the above
Other (please specify)
Please Specify the Incident
*
What happened?
*
Provide a summary of the incident/near miss including lead up to the event and details on the outcome.
Immediate Action Taken
*
--- Select Choice ---
No Action Required
First Aid
Emergency services called
Other (Please Specify)
Please specify the Immediate Action Taken
*
Was the incident related to work?
*
--- Select Choice ---
Yes
No
Not sure
Was appropriate Personal Protective Equipment worn (if applicable)
Yes
No
Not sure
Submit
