Safer Churches - Incident / Near Miss Report

INFORMATION ABOUT PERSON(S) INVOLVED IN INCIDENT

INFORMATION ABOUT INCIDENT

TYPES OF INCIDENTS:

Incident involving injury           

Note: This does not only include cases where Breakthrough is at fault – include all cases that take place on BCC property or at a BCC event. 

eg. Two children clash heads and need ice applied to bumps in a Jumping Castle at BCC Family Day Event, A person injures their knee tripping over a vacuum cleaner.

Incident NOT involving injury 

eg. A child gets a fright and wets themselves, a verbal fight in the carpark

A near miss

An incident where no-one is affected but someone could have been. The purpose is to help us improve our OHS.

eg. A worship team member trips over a cord on stage, An electric jug is knocked over in the kitchen spilling boiling water, A car carrying Youth to an event blows a tyre.

INJURY REPORT

OTHER INFORMATION

PERSON MAKING THE REPORT DETAILS

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FOR OFFICE USE ONLY

FOLLOW UP ACTION OF INCIDENT

Document any follow up action taken after the incident (including both before and after Report)

Include items such as:

  • Insurance notifications/claims
  • Discussion with parents/guardians
  • Discussion with BCC Leaders and OHS/Safe Churches Representatives
Date Action Taken                    By Whom

 

 

 

   

 

 

 

   

 

 

 

   

 

REDUCING RISK

Document the Safety Team’s Discussion following this event, and what will be done to decrease the possibility of future occurrences:

(Include in description if decision is that this was a once off event, and no action will be taken)

Date Action Taken                    By Whom