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Incident Report Form

This form is to be used to report all injuries, illnesses, or near misses, whether an injury occurred or not, and to document the investigation.
Please complete within 24 hours of the incident.

Required fields in the form are marked with an *


SECTION A: TO BE COMPLETED BY PERSON INVOLVED

DETAILS OF PERSON INVOLVED


DETAILS OF THE INCIDENT


PART OF BODY AFFECTED


DETAILS OF THE INCIDENT/INJURY/NEAR MISS


SECTION B: TO BE COMPLETED BY THE SUPERVISOR & THE PERSON INVOLVED WITHIN 48 HOURS

This is an extremely important section as the aim of the incident investigation is to identify preventative action that will avoid recurrence.

DETAILS OF THE CAUSE OF THE INCIDENT/INJURY/NEAR MISS


PREVENTION OF INCIDENT RECURRENCE


DETAILS OF PROFESSIONAL SERVICES INVOLVED


LOCAL ADMINISTRATORS DETAILS


Thank you for completing the online Incident Report Form.
By submitting this form you accept responsibility to the actual events and outcomes possibly attained from this incident as a true statement.

January 2022 CTSN

On the cover: ERN WILLIAMS from the Wangaratta Club, ACTA’s only Centenarian– still shooting regular practice & competition

Inside this month's edition

ACTA Report
MCMS Grading Data
VCTA State Trap Carnival
Lake Albert’s 43rd Anniversary
Ern Williams, ACTA Centenarian
ACTA State Handicappers
2021 Final Shoot for Boyup Brook
ACTA Coaching News
42nd Central Victorian Grand Prix
Around the Traps in Tasmania
Break Badges
Psychological Skills for Shooting
Glenn Trophy Results
VCTA North West Zone 2021 DTL Carnival
What’s Happening in the VCTA
Competition Results: VIC, TAS, SA, QLD, WA, NSW
Christmas Cheer at Bega
ACTA New Members
Classifieds
Shoot Calendar
2022 Registration & Club Membership Application


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This month's CTSN

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02 6938 2121