Incident / Injury Response (Must be completed for all Injuries / Incidents)

High Risk Category (the most significant risk category, if any, that relates to the incident) (Refer to 291 Meaning of “high risk construction work”)

Involves A Risk Of A Person Falling More
Than 2 Meters

Is Carried Out On Or Near Chemical, Fuel Or
Refrigerant Lines

Is Carried Out On A Telecommunication Tower

Is Carried Out On Or Near Energised Electrical
Installations Or Services

Involves Demolition Of An Element Of A Structure That
Is Load-bearing Or Otherwise Related To The Physical
Integrity Of The Structure

Involves Diving Work

Involves, Or Is Likely To Involve, The Disturbance Of
Asbestos

Involves Tilt-Up Or Precast Concrete

Involves Structural Alterations Or Repairs That Require
Temporary Support To Prevent Collapse

Is Carried Out On, In Or Adjacent To A Road, Railway,
Shipping lane Or Other Traffic Corridor That Is In Use
By Traffic Other Than Pedestrians

Is Carried Out In Or Near A Confined Space

Is Carried Out In An Area At A Workplace In Which
There Is Any Movement Of Powered Mobile Plant

Is Carried Out In Or Near A Shaft Or Trench With An
Excavated Depth Greater Than 1.5 Metres, Or A Tunnel

Is Carried Out In An Area In Which There Are
Artificial Extremes Of Temperature

Is Carried Out On Or Near Pressurised Gas Distribution
Mains Or Piping

Other Details:

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