Incident Investigation Report | JET Excavators

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Incident Report Form

First Name

Last Name

Position

Position

Contact Number

Incident Details

Date of incident

Time of incident

Location of incident

Description of the incident (what happened, in chronological order)

Were there any witnesses?

Was any property damaged?

If yes, what was the name of the witness or witnesses. If possible please provide there contact details.

Details of injuries sustained

What was the type of injury that was sustained? * Required

Musculoskeletal Injuries: These include strains, sprains, fractures, and repetitive strain injuries. They often occur due to heavy lifting, repetitive movements, or improper handling techniques.

Cuts and Abrasions: These can result from working with sharp tools, machinery, or materials. They can vary in severity from minor cuts to serious lacerations.

Falls, Trips, and Slips: These injuries can lead to fractures, dislocations, or bruises. Wet floors, uneven surfaces, poor lighting, or loose carpeting often contribute to these incidents.

Hearing Loss: Long-term exposure to loud noise can lead to permanent hearing loss or damage. This is common in industries like manufacturing, construction, or mining.

Respiratory Issues: Exposure to dust, chemicals, or toxins can lead to respiratory problems such as asthma, bronchitis, or chronic obstructive pulmonary disease (COPD).

Eye Injuries: These can result from flying debris, chemical splashes, or intense light sources. Eye injuries can include scratches, burns, or even permanent blindness.

Crushing Injuries: Working with heavy machinery or in environments with potential falling objects can lead to crushing injuries, causing fractures, internal injuries, or fatalities.

Electric Shocks: Exposure to live electrical components can result in shocks or burns. In severe cases, this may cause cardiac arrest or other serious health complications.

Mental Health Issues: Work-related stress, harassment, or violence can lead to mental health problems like anxiety, depression, or post-traumatic stress disorder (PTSD).

Environmental Injuries: These include heatstroke, frostbite, or other conditions caused by working in extreme temperatures or weather conditions.

Amputations: Severe injuries involving machinery or equipment can result in the loss of fingers, limbs, or other body parts.

What part of the body was affected? * Required

Head

Face

Neck

Spine

Right shoulder

Left shoulder

Right arm

Left arm

Right hand

Left hand

Right Hand Fingers

Left Hand Fingers

Chest

Abdomen

Upper back

Lower back

Middle back

Right hip

Left hip

Right leg

Left leg

Right foot

Left foot

Respiratory System

Skin

Mental Health

Sensory Organs

Multiple Body Parts

To help with the report please upload any relevant photos of the incident

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Please sign and submit the incident report

Thanks for submitting!

theteam@jetexc.com.au

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Location

37-39 Industrial Ave,

Logan Village QLD 4207

(07) 3841 3337
theteam@jetexc.com.au

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