APPENDIX 8-5
BACKGROUND INFORMATION DOCUMENT – ROUND 3
                   APPENDIX 8-6
NEWSPAPER ADVERTISEMENT – ROUND 3
            APPENDIX 8-7
MINUTES AND SIGNATURES FOR
    CONSULTATION – ROUND 3
ACCIDENT REPORT TEMPLATE
Accident Report                                               FORM – Worker’s Health and Safety

To :                    Site Supervisor


Accident:                                                Date & Time:
Location :                                               Report by :


Contact Information :


                                                                                  Provide Details
            Consequences
                                                                        (what, where, how many, how much)
                                      Injuries :
Impact on people :
                                      Fatalities :
                                      Building :
                                      Equipment: (IT, Tel., etc.)
Impact on Property :
                                      Utilities :
                                      Site accessible :
                                      Spill, leak :
Surrounding :
                                      Neighbors :
                                      On site :
Media :                               Potential to attract :
                                      Spokesperson notified :
                                      Disrupted temporary :
Business Continuity :
                                      Could lead to disruption :
                                                   1                        2                    3
Incident Level: (circle the level)
                                      Contained and Isolated      Potentially Serious :     Very Serious
Incident witness people notified:

End of Preliminary Report – Complete following items when accident is resolved
Cause of Outage and Resolution:
Chain of Events and Activities :
Internal and External Contributors:
Follow-up Activities:
Strong / Weak Points/Recommendations:
Costs incurred due to this incident:
Equipment:
Travel:
Manpower:
Overtime;
Others:


 Issue Date : June 2018                                                                                1 of
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