Incident and Hazard Report Form
v2.0
Purpose. Any worker completes this form to report an injury, chemical reaction, needle stick, near miss, hazard or property damage at a Luxe site.
1.When to use this form
Complete this form for any event that hurt or nearly hurt a person, damaged property or exposed a person to a chemical or blood. Complete it on the day of the event, before the end of your shift, even if the person seems fine. Hazards you notice that have not yet caused harm are reported on the same form.
2.What to write
Describe what happened in the order it happened, using plain words and facts. Name the products, tools and equipment involved. Do not write opinions about fault. Record who was present and what first aid or action was taken immediately.
3.Where it goes
Hand the form to the floor leader, who must enter it in the incident register and forward it to the Operations and Compliance Manager. The floor leader must isolate any equipment or product involved until it is reviewed.
4.Investigation
The Operations and Compliance Manager will contact the reporter within two working days, investigate the causes and record corrective actions in the register. The reporter will be told what was decided.
5.Notifiable incidents
Serious injuries, needle sticks involving a client, and any event requiring hospital treatment must be phoned through to the Operations and Compliance Manager immediately as well as recorded on this form.