You must also notify the Department of Labour in
writing (now part of the Ministry of Business, Innovation and Employment) within
7 days. The notification must supply the
following information:
1.
Your business name.
2.
Your postal address.
3.
Your telephone number.
4.
Whether you are the employer, self-employed or
principal.
5.
Location of place of work.
6.
Name of injured person.
7.
Address of injured person.
8.
Occupation of injured person.
9.
Whether the injured person is an employee, contractor,
yourself or some other person.
10.
If an employee how long they have been employed.
11.
Whether they have been treated, first aid, doctor,
hospital.
12.
Date and time of accident.
13.
Hours worked before accident.
14.
How the accident occurred:
- Fall, trip
or slip
- Sound or
pressure
- Body
stressing
- Biological
- Mental
stress
- Hitting
object with body
- Being hit
by object
- Heat,
radiation or energy
-
Chemicals
15.
Agency of accident/serious harm:
- Machinery
(fixed)
- Machinery
(mobile) or transport
- Power
tools
- Chemicals
- Materials
- Environmental
e.g. dust or gas
- Animal,
human or biological
-
Bacteria or virus
16.
Body Part:
- Head
- Neck
- Trunk
- Upper limb
- Lower limb
- Multiple
locations
-
Systemic internal organs
17.
Nature of Injury (mark all applicable):
- Fracture
of spine
- Other
facture
- Dislocation
- Sprain or
strain
- Head
injury
- Internal
trunk injury
- Amputation
(including eye)
- Open wound
- Superficial
injury
- Bruising
or crushing
- Foreign
body
- Burns
- Nerves or
spinal cord
- Puncture
wound
- Poisoning
or toxic
- Multiple
injuries
- Damage to
artificial aid
- Disease,
nervous system
- Disease,
musculoskeletal system
- Disease,
skin
- Disease,
digestive system
- Disease,
infectious or parasitic
- Disease,
respiratory system
- Disease,
circulatory system
- Tumour
(malignant or benign)
- Mental
disorder
-
Fatal
18.
Where and how did the accident/serious harm happen?
19.
Employer to specify if investigation has been carried
out and whether a significant hazard was involved.
20.
The notification must be signed and dated with the
name and job position of the person signing.
A form can be
downloaded from the Ministry of Business Innovation & Employment
website.
If you need to report
a Hazardous Substance Emergency call the Fire Service on 111 and also the MBIE
contact centre on 0800 209 020.
You must not disturb
an accident scene except to protect life or property (in some
circumstances). For scene clearance by a
health & safety inspector call 0800 209 020.
In a recent case an
employer was fined $60,000 for failing re report a workplace accident and in
another case fines for non-reporting of $50,000 to $100,000 were sought as this
prevented the accidents being investigated.
You need to be aware
of not only your obligations to prevent accidents/harm but also to report any
that do occur.
Alan Knowsley
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