Opera Australia Incident and Injury Report Form - Confidential

This form is used to report OHS incidents and injuries and near misses. The form is used for staff, contractors, volunteers and visitors.

A separate form is completed for each person with a work related injury. It is a requirement that:
1. All work related incident/injuries are reported to the immediate manager and Human Resources, as soon as possible.
2. All injuries are notified on this form as soon as possible to assist early treatment and support and to meet legal reporting requirements.

If an injured person is unable to complete this form having otherwise notified the injury, the manager or another staff member should complete and submit it.

What and how and incident and/or injury occurred.

Where did it happen? (e.g. on stage, wardrobe area, workshop etc)

Please provide all eyewitnesses' names, job titles, and contact numbers. If no eyewitnesses, please insert N/A.

Was any action taken to rectify the situation? E.g. did the injured person refrain from using any part of their body, were there any adjustments made the tools or sets?

If Yes, complete sections 3, 4 and 5.

Please provide full name, date, time and description of treatment administered.

Please indicate whether a workers compensation claim needs to be lodged for the purposes of taking treatment or time off as a result of this injury.

Please upload any additional documents such as a WorkCover Certificate of Capacity, doctor's certificate, receipts, or first aid treatment paperwork. Without supporting paperwork and a WorkCover Certificate of Capacity, your claim cannot be lodged.

For further information and/or support, please contact either Bill Koukoumas (02 9318 8399) or Nitya Ramaswamy (02 9318 8227) in Human Resources.

If you have receipts and/or certificates of capacity at a later stage, please email them to either Bill.Koukoumas@opera.org.au or Nitya.Ramaswamy@opera.org.au.

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