The Hazard Incident Report Form is a crucial document required under Malaysian workplace safety legislation, specifically designed to meet the requirements of the Occupational Safety and Health Act 1994 and associated regulations. This form must be completed whenever a workplace hazard is identified, a near-miss occurs, or an actual incident takes place within any Malaysian workplace. It serves multiple purposes: documenting the incident details, tracking immediate responses, identifying affected parties, recording witness statements, and initiating the investigation process. The form ensures organizations maintain proper records for internal safety management and compliance with regulatory reporting requirements, while also providing essential data for preventing future incidents.
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1. Report Identification: Unique report ID, date and time of report creation, and facility/location information
2. Incident Details: Date, time, and specific location of the incident, type of incident (near-miss, accident, dangerous occurrence)
3. Reporter Information: Name, position, contact details of the person reporting the incident
4. Incident Description: Detailed narrative of what happened, including sequence of events and immediate actions taken
5. Affected Persons: Details of all persons involved or injured, including employees, contractors, or visitors
6. Immediate Response: Actions taken immediately after the incident, including emergency response and first aid measures
7. Witness Information: Names and contact details of witnesses to the incident
8. Initial Risk Assessment: Preliminary evaluation of the incident severity and potential consequences
9. Immediate Corrective Actions: Steps taken to prevent immediate recurrence and secure the area
1. Environmental Impact: Details of any environmental effects or concerns, used when incident involves spills or emissions
2. Equipment/Machinery Involved: Specific details about equipment or machinery involved in the incident, used when applicable
3. Chemical Exposure: Information about chemical substances involved, including SDS references, used for chemical-related incidents
4. Property Damage Assessment: Details of damage to property or assets, used when physical damage occurs
5. External Agency Notification: Details of notifications to authorities, used when incident requires reporting to regulatory bodies
6. Media/Public Relations: Communication management details, used for significant incidents with public impact
1. Appendix A - Incident Scene Photographs: Photographic documentation of the incident scene and any visible damage
2. Appendix B - Witness Statements: Detailed statements from witnesses, using standard witness statement forms
3. Appendix C - Medical Reports: Copies of relevant medical reports or first aid records
4. Appendix D - Risk Assessment Matrix: Standard risk assessment tool for evaluating incident severity and likelihood
5. Appendix E - Equipment/Machinery Documentation: Relevant maintenance records, operation logs, or certification documents
6. Appendix F - Incident Location Map: Site plan or map marking the exact location of the incident
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