(M)
Type or double click to select the staff member on duty
when the accident occurred.
Activity at Time of Accident
Type the activity that was taking place at the time
of the accident.
What happened
Type what directly caused the accident/injury.
Contributing factors
Type any contributing factors to the accident.
Action for Person's Welfare
Type what action was taken to assist the injured person.
Action to Prevent Recurrence
Type what action was taken to prevent a recurrence of
the accident.
Protective clothing
Click this tick box if protective clothing was being
worn when the accident occurred (if relevant).
Verbal Instructions
Click this tick box if verbal instructions and cautions
were given before the accident occurred.
Written Instructions
Click this tick box if written instructions were provided
before the accident occurred.
Supervision
Click this tick box if supervision was being provided
at the time of the accident.
Safety Guards
Click this tick box if safety guards were present at
the time of the accident (if relevant).
N/A
This tick box if none of the above safety measures apply.
Notifiable Accident - was DAIS notified? (Refer OHSW
Regulations - Division 6.6)
This tick box will be selected if the accident is classified
as notifiable (and therefore the Department of Administrative and Information Services
informed).
Copyright (c) 2000 by
Department for Education
Last revised 14/08/2007
email to:
decdcsc@sa.gov.au
![[stu126.gif]](stu126.gif)