Yes No Notify return to work coordinator Name of return to work Coordinator

Yes no notify return to work coordinator name of

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Yes No Notify return to work coordinator Name of return to work Coordinator Witness to incident (each witness may need to provide an account of what happened) Witness name Witness contact Witness name Witness contact Details of incident (eg property, plant or environmental damage) Date of incident Time of incident am pm Location of incident Details of damage to Equipment or property Name of person who Telephone Received the report
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16 ADDENDUM | © 2019 YOUNG RABBIT PTY LTD, AUSTRALIAN PACIFIC COLLEGE BSB20115 CERTIFICATE II IN BUSINESS & BSB20215 CERTIFICATE II IN CUSTOMER ENGAGEMENT | BASIC WHS_V8.2 Description of incident Immediate response actions (eg barricades, isolation of power) to stabilise the situation Reported to Reported to principal contractor? Yes No Provide details (when, reported to and reported by): Reported to authorities (WorkCover phone: 13 10 50 )? Yes No Provide details (when, reported to and reported by): Reported to principal contractor? Yes No Provide details (when, reported to and reported by): Reported to workers compensation insurer? Yes No Provide details (when, reported to and reported by): Completed by Name Position Signature Date 3. Who would you report this incident to? (2 marks)Part B total: 14 marks
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  • Rabbit, YOUNG RABBIT PTY LTD

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