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02 6938 2121

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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.

May 2022 CTSN

On the cover: Trap Nationals Overall High Gun - Glenn Barton

Inside this month's edition

ACTA Report
Australian Shotgun Team Returns to International Competition
Vision and Shooting
2022 ACTA Trap Nationals
2022 State Teams
2022 ACTA Trap Hall of Fame Dinner
Dallas O’Keefe, $30,000 Roman Bounty Winner
Psychological Skills for Shooting
Competition Results: VIC, QLD, TAS, SA, WA, NSW
Toowoomba Skeet Carnival
Toowoomba Trap Carnival
Bega Beats the Rain in April
Break Badges
ACTA New Members
Shoot Calendar
2022 Registration & Club Membership Application


Download PDF          View FLIPBOOK
This month's CTSN

Call the National Office

02 6938 2121