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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.

September 2021 CTSN

On the cover: Matt Patmore, Northern Territory State DTL Carnival High Gun

Inside this month's edition

ACTA Report
Darwin CTC Annual Four Day Shoot and NTCTA DTL State Carnival
Great News for Club Advertising
QCTA State ISSF Carnival
WACTA 5 Stand Sporting Carnival
Vale – Dexter Barnes
Psychological Skills for Shooting
ACTA State Rules Supervisors
Pearce’s Day at Bega
What’s Happening in the VCTA
Break Badges
ACTA New Members
Competition Results: NSW, TAS, WA, SA, QLD, VIC
Coaching News
From Our Archives
Classifieds
Shoot Calendar


Download PDF          View FLIPBOOK
This month's CTSN

Call the National Office

02 6938 2121