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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.

April 2021 CTSN

On the cover: Michael Veenstra, 2021 SA State DTL Carnival Overall High Gun

Inside this month's edition

ACTA Report
2020 South Australian State Trap Carnival
What’s Happening in the VCTA
Psychological Skills for Shooting
Coaching News
ACTA State Rules Supervisors
Fimac Engineering Handicap at Bega
41st Norfolk Island International Championships
Waratah News
National Skeet Championships Conditions of Entry
National Skeet Championships Program
Competition Results: SA, TAS, NT, VIC, NSW, WA, QLD
8th Terry Faulks Memorial Day at Tyagarah
Mixed Target Event Shot at Southern CTC
Previous Skeet Nationals Winners
Break Badges
ACTA New Members
Shoot Calendar
2021 Registration and Club Membership Application


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This month's CTSN

Call the National Office

02 6938 2121