The Hazard Incident Report Form is a critical document used to record and report workplace safety incidents in accordance with Irish legislation, particularly the Safety, Health and Welfare at Work Act 2005 and associated regulations. This form must be completed whenever a workplace accident, near-miss, or dangerous occurrence takes place, facilitating proper documentation for legal compliance, insurance purposes, and organizational risk management. It captures essential information about the incident, including circumstances, parties involved, immediate actions taken, and required notifications to relevant authorities such as the Health and Safety Authority (HSA). The form is designed to ensure thorough incident documentation while maintaining compliance with data protection requirements under GDPR and the Data Protection Act 2018.
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1. Incident Identifier: Unique reference number, date, time, and location of the incident
2. Reporter Details: Name, role, and contact information of the person reporting the incident
3. Incident Classification: Type of incident (accident, near-miss, dangerous occurrence), severity level, and primary hazard category
4. Incident Details: Detailed description of what happened, immediate causes, and sequence of events
5. Persons Involved: Details of all persons involved, including any injured parties, witnesses, and their roles
6. Immediate Actions Taken: Description of immediate actions taken to secure the area and prevent further harm
7. Initial Assessment: Preliminary assessment of the incident's causes and contributing factors
8. Medical Treatment Required: Details of any first aid or medical treatment provided
9. Notification Requirements: Checklist of authorities and stakeholders who need to be notified (HSA, management, etc.)
10. Documentation: List of supporting documents (photos, witness statements, etc.) attached to the report
1. Environmental Impact: To be completed when the incident involves environmental hazards or spillages
2. Equipment Damage: Details of any damage to equipment or property, to be completed when applicable
3. Third Party Involvement: Information about any contractors, visitors, or members of the public involved
4. Business Impact Assessment: Assessment of impact on business operations, to be completed for serious incidents
5. Media Communications: To be completed if the incident may require media communications or public statements
1. Appendix A - Hazard Classification Guide: Reference guide for classifying different types of hazards and incidents
2. Appendix B - Risk Assessment Matrix: Tool for assessing the severity and likelihood of incidents
3. Appendix C - Emergency Contact List: List of emergency contacts and reporting authorities
4. Appendix D - Incident Investigation Checklist: Checklist for ensuring thorough incident investigation
5. Appendix E - Witness Statement Form: Template for recording witness statements
6. Appendix F - Photo Log Template: Template for documenting photographic evidence
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