Who has been injured?

If a client has been injured complete a Clinical Incident Form. If you or another employee have been injured continue with the WHS Incident Report.

Person Reporting the Incident

Incident Categorisation

Date & Time of Incident

9:30am or 0930 hrs

Incident Location


Full Description of the incident location and incident events

i.e. describe the layout of the working space identifying proximity to fixtures, equipment or other persons present. Any additional documents or photographs can be attached
Provide a detailed description of the incident

Please identify any injuries sustained

Treatment Provided following Incident

Witness to Incident

Please attach items such as sketches, medical certificates or other documentation.


I have read and understood the privacy policy surrounding collection, storage and use of information submitted electronically.


Further Information