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Health And Safety Incident Report Form

Health And Safety Incident Report Form Template for Malaysia

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Key Requirements PROMPT example:

Health And Safety Incident Report Form

"I need a Health and Safety Incident Report Form for our manufacturing facility in Penang that includes both English and Bahasa Malaysia versions on the same form, with specific sections for machinery-related incidents and chemical exposure."

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Document background
The Health and Safety Incident Report Form is a crucial document required under Malaysian workplace safety regulations, specifically designed to comply with the Occupational Safety and Health Act 1994 and related regulations. This form must be used to report any workplace accident, dangerous occurrence, occupational poisoning, or occupational disease to the Department of Occupational Safety and Health (DOSH). It captures essential information about the incident, including details of affected persons, circumstances, immediate actions taken, and proposed preventive measures. The form serves multiple purposes: ensuring regulatory compliance, facilitating incident investigation, supporting insurance claims, and contributing to workplace safety improvements. It should be completed as soon as possible after an incident occurs, with certain serious incidents requiring notification to DOSH within 7 days.
Suggested Sections

1. Report Identification: Form number, date of report, and reference details

2. Incident Overview: Basic information including date, time, and location of incident

3. Type of Incident: Classification of incident (accident, near-miss, dangerous occurrence, occupational disease)

4. Affected Person(s) Details: Information about injured/affected person(s) including name, employee ID, job title, department

5. Incident Description: Detailed account of what happened, including sequence of events

6. Immediate Actions Taken: Emergency response and immediate control measures implemented

7. Witness Information: Details of witnesses and their initial statements

8. Initial Assessment: Preliminary evaluation of incident severity and potential consequences

9. Investigation Details: Findings from investigation, including root causes and contributing factors

10. Corrective Actions: Measures to be implemented to prevent recurrence

11. Reporting Authority: Details of person completing the report and responsible manager

Optional Sections

1. Medical Treatment Details: Used when medical attention was required, including first aid or hospital treatment

2. Equipment/Machinery Involved: Required when incident involves machinery or equipment failure

3. Environmental Impact: Used when incident has environmental implications

4. Chemical Exposure Details: Required for incidents involving hazardous substances or chemical exposure

5. Property Damage Assessment: Used when incident resulted in damage to property or assets

6. Production Impact: Required when incident affects production or operations

7. Third Party Involvement: Used when contractors, visitors, or public are involved in the incident

Suggested Schedules

1. Incident Scene Photographs: Attachment for photos documenting the incident scene and damages

2. Witness Statement Forms: Detailed written statements from witnesses

3. Medical Reports: Copies of relevant medical documentation

4. Risk Assessment Review: Review of existing risk assessment related to the incident

5. Investigation Timeline: Detailed timeline of events leading to and following the incident

6. Equipment Inspection Records: Relevant maintenance and inspection records for involved equipment

7. Training Records: Copies of relevant training records for involved personnel

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓƵ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions






























Clauses




















Relevant Industries

Manufacturing

Construction

Oil and Gas

Healthcare

Mining

Agriculture

Transportation

Logistics

Hospitality

Retail

Education

Chemical Processing

Food Processing

Pharmaceutical

Automotive

Electronics Manufacturing

Utilities

Telecommunications

Warehousing

Facilities Management

Relevant Teams

Health Safety Environment

Operations

Human Resources

Risk Management

Compliance

Quality Assurance

Facilities Management

Security

Emergency Response

Occupational Health

Production

Maintenance

Legal

Administration

Employee Relations

Relevant Roles

Health and Safety Manager

Safety Officer

Department Supervisor

Plant Manager

Facility Manager

Human Resources Manager

Risk Management Officer

Operations Manager

Production Supervisor

Maintenance Manager

Quality Control Manager

Environmental Health Officer

Compliance Officer

Site Manager

Factory Manager

HSE Coordinator

Emergency Response Coordinator

Occupational Health Nurse

Security Manager

Line Supervisor

Industries





Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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