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    • ESL Installation Services
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Incident Report

To be completed by the Crew Leader following any safety incident, injury, near miss or hazard. Please notify your State Manager of any incident immediately.

Step 1 of 6

16%
DD slash MM slash YYYY
Please select your Country(Required)
Your State(Required)
Crew Leader's Name(Required)
DD slash MM slash YYYY
Time of incident(Required)
:
Type of Incident
Name of Injured person
Address of Injured person
Injured Person's Date of Birth
Employment Status
Is this a re-occurance of a previous injury?
Witness Name
Injury Type
Injury Occurance
Was First Aid assistance provided?
If Yes, First Aider's Name
Injury Treatment Outcomes - did the injured person...?

Safety Champion/Crew Leader Investigation

Contributing Factors
Incident investigation photos
Accepted file types: jpg, jpeg, png, gif.
Incident investigation photos
Accepted file types: jpg, jpeg, png, gif.
Consent(Required)
I acknowledge that the information provided is true and correct. I allow all information provided to be used with discretion, by Crew Services Group in workcover claims and to assist with improving WHS policies and procedures for all employees

 

 

 

 

 

 

 

 

 

About Us

Crew Services Group is the leading provider of retail and supplier services

Quick Links

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Crew Resources

  • Crew Login Portal/Induction
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Contact Information

  • 1800 692 739
  • info@crewservices.com.au
  • Suite 7/486 Lower Heidelberg Rd, Heidelberg VIC 3084, Australia

#LoveWhereYouWork

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