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Project Incident Report (Incident Details (preliminary) (Impact^ (Health,…
Project Incident Report
Indent Time and Location
Date of incident
Time of incident
Work Area
Location Description
Select (Highlight) One Accountable Organisation Unit/Are Manager
Greg Field-Mining(31087107)
Gregory Garnett Mining 1(31226495)
Sam Hewitt Decline
(31095344)
Andy Curtis
Underground
(31095602)
Richard Hudson
Geotechnical Services
(31095346)
Claire Stuetzel
Technical Services
(31095601)
Philip Requadt Mine Co-ordination
(31095348)
Ron Gordon Maintenance (31095347)
Chris Aitchison – Construction and Shaft Sinking (31087103)
Mauricio Carrillo
Underground Construction
(31095861)
Grant Brinkmann
Shafts
(31095350)
David Bayona
Surface Facilities
(31095860)
Contractor Company Name
Incident Details (preliminary)
Near Miss^
Yes
No
Impact^
Health
Safety
Environment
Community
Quality
Process
Security
Equipment Damage
Actual Consequence^
Minor
Medium
Serious
Major
Catastrophic
Maximum Reasonable Outcome^
Short Description*
Long Description
Immediate Actions
Involved People
Role Type
Incident Reporter
Lead Investigator
Uninjured Involved Person
Injured / Ill Person
Owners Team HSE Rep
Safety/Health Employee Rep
Name
SAP Number
Role Title