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Incident Response Form

Incident Response Form Template for New Zealand

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Key Requirements PROMPT example:

Incident Response Form

"I need an Incident Response Form for our healthcare facility that specifically addresses patient data breaches and medical emergencies, ensuring compliance with both healthcare regulations and New Zealand privacy laws."

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Document background
The Incident Response Form is a critical document used to record and manage various types of incidents within organizations operating in New Zealand. It is designed to ensure compliance with key legislation including the Health and Safety at Work Act 2015, Privacy Act 2020, and other relevant regulations. The form should be used immediately following any significant incident, near-miss, accident, or breach that requires formal documentation and response. It captures essential information about the incident, involved parties, immediate actions taken, and preliminary analysis, serving as both an immediate response tool and an official record. The document supports systematic incident management, helps identify trends and patterns in incidents, and provides evidence of due diligence in responding to and investigating incidents. Organizations should maintain completed Incident Response Forms as part of their compliance records and use them to inform preventive measures and policy improvements.
Suggested Sections

1. Incident Reporter Details: Information about the person reporting the incident, including name, role, contact details, and relationship to the incident

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

3. Incident Description: Detailed narrative of what occurred, including sequence of events and immediate actions taken

4. Affected Parties: Details of all individuals involved in or affected by the incident, including any injuries or impacts

5. Immediate Response Actions: Steps taken immediately following the incident discovery, including emergency responses and notifications made

6. Witness Information: Details of any witnesses to the incident, including their contact information and initial statements

7. Impact Assessment: Evaluation of the incident's impact on operations, people, assets, and reputation

8. Evidence and Documentation: List of any evidence collected, including photos, videos, documents, or physical items

9. Initial Root Cause Analysis: Preliminary assessment of what caused the incident

Optional Sections

1. Privacy Breach Details: Used when the incident involves unauthorized access to or disclosure of personal information, as required by Privacy Act 2020

2. Health and Safety Specifics: Used for incidents involving injury, near-misses, or workplace safety concerns, aligned with Health and Safety at Work Act 2015

3. IT Security Details: Used for cybersecurity incidents, including system affected, type of breach, and technical details

4. Environmental Impact: Used when incident involves environmental damage or risks

5. Equipment/Asset Damage: Used when physical assets or equipment are damaged in the incident

6. Regulatory Reporting Requirements: Used when incident requires notification to regulatory bodies

7. Media and Communications: Used for high-profile incidents requiring public communications or media management

Suggested Schedules

1. Incident Classification Guide: Reference guide for categorizing different types of incidents and their severity levels

2. Emergency Contact List: List of key contacts to be notified based on incident type and severity

3. Required Notification Checklist: Checklist of internal and external parties to be notified based on incident type

4. Evidence Collection Guidelines: Procedures for properly collecting and documenting different types of evidence

5. Risk Assessment Matrix: Tool for evaluating the severity and priority of the incident

6. Relevant Forms and Templates: Additional forms required for specific types of incidents (e.g., WorkSafe NZ forms)

7. Post-Incident Review Template: Template for conducting thorough incident analysis and developing preventive measures

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

Healthcare

Financial Services

Education

Government

Manufacturing

Technology

Retail

Transportation

Construction

Energy

Telecommunications

Professional Services

Mining

Agriculture

Hospitality

Non-profit Organizations

Relevant Teams

Human Resources

Health and Safety

Risk Management

Legal

Compliance

Operations

Security

Information Technology

Facilities Management

Quality Assurance

Emergency Response

Environmental Management

Corporate Communications

Senior Management

Relevant Roles

Chief Executive Officer

Health and Safety Manager

Risk Manager

Department Manager

Supervisor

Human Resources Director

Privacy Officer

Security Manager

Compliance Officer

Operations Manager

Facility Manager

Environmental Health and Safety Coordinator

Quality Assurance Manager

Site Manager

Project Manager

IT Security Manager

Emergency Response Coordinator

Employee Relations Manager

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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