Notifiable Incident Report Form
WSACT FM 0006
Page 2 of 5
Is there a time limit for reporting?
Notifiable Incidents must be notified to WorkSafe ACT immediately after the workplace becomes aware that a
notifiable incident arising out of the conduct of the business or undertaking has occurred.
If the notification is made by telephone, WorkSafe ACT may require that written notice be provided [using this form, for
example] within 48 hours of that requirement being made.
What injuries must you report?
You must send WorkSafe ACT a Notifiable Incident Report if, as a result of a Notifiable Incident at your workplace,
involving:
• the death of a person [i.e. a worker or another person]
• a serious injury or illness of a person
• a dangerous incident
in accordance with sections 35 to 39 of the Work Health and Safety Act 2011 and the Work Health and Safety
Regulations 2011. It is an offence to fail to make a report of a Notifiable Incident.
You must send WorkSafe ACT a Report even if the person injured or killed is not a worker (e.g. a sales representative
or a visitor).
What is a Serious Injury or Illness?
A serious injury or illness means an injury or illness requiring the person to have:
• immediate treatment as an in-patient in a hospital [Note: it is not necessary that the person was actually
sent to or treated as an in-patient, it is sufficient that the injury or illness could reasonably be
expected to warrant such treatment]
• immediate treatment for an amputation, a serious head or eye injury, a serious burn, degloving or scalping, a
spinal injury, the loss of a bodily function or serious lacerations
• medical treatment within 48 hours of exposure to a substance.
What dangerous incidents must you report?
A dangerous incident means an incident in relation to a workplace that exposes a worker or any other person to a
serious risk to a person’s health or safety emanating from an immediate or imminent exposure to:
• an uncontrolled escape, spillage or leakage of a substance
• an uncontrolled implosion, explosion or fire
• an uncontrolled escape of gas, steam or a pressurised substance
• electric shock
• the fall or release from height of any plant, substance or thing
• the collapse, overturning, failure or malfunction of, or damage to, any plant that is required to be authorised
for use in accordance with the WHS Regulations 2011
• the collapse or partial collapse of a structure
• the collapse or failure of an excavation or of any shoring supporting an excavation
• the inrush of water, mud or gas in workings, in an underground excavation or tunnel
• the interruption of the main system of ventilation in an underground excavation or tunnel
• any other event prescribed by the WHS Regulations 2011.
Do you have to keep a copy?
You must keep a record of any Notifiable Incident notification that you make to WorkSafe ACT for at least 5 years after
the day the notification is given.
Do you need to comply with any other accident report procedures?
You may have reporting obligations under other legislation including but not limited to the: Scaffolding and Lifts Act
1912, Workers Compensation Act 1951, Machinery Act 1949 and/or the Dangerous Substances Act 2004 in relation to
the Notifiable Incident that you have told WorkSafe ACT about in this Report.
Can you fax or phone in details?
Yes. When notifying by phone, you should ensure you receive and record the report number given to you by
WorkSafe ACT. This report number needs to be kept with your records of the details reported to WorkSafe ACT.
WorkSafe ACT, PO Box 158 Canberra ACT 2601 Phone: (02) 6207 3000 Fax: (02) 6205 0336
Email: worksafe@works
afe.act.gov.au
www.worksafe.act.gov.au
WSACT_FM_0006a_-_Notifiable_Incident_Report-2013.doc Last Updated
May 2012
