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Incident Defect Report

Home > Incident Defect Report

THIS REPORT IS NOT A SUBSTITUTE FOR IMMEDIATE TELEPHONE ADVICE TO THE SAFETY MANAGER 0438 347 574 (SPEED DIAL 413) AND TO OTHERS CONCERNED WHEN REQUIRED.

*MUST COMPLETE

Name of Person Completing Report*
Contact Phone Number [ (03)xxxx xxxx or (04xx) xxx xxx]*
Rostered Position*
Email Address*
Select the appropriate option*
* An incident is an unplanned event resulting in damage, service interruption, injury, ill health, or other loss.
* A defect is a fault or other imperfection.
* An injury is when the body, or part of the body, is harmed.
* A near-miss is an unplanned event that under different circumstances may have caused damage, service interruption, injury, ill health, or other loss.
* A hazard is a potential source of harm that, if not fixed, may cause an incident or injury
- Incident
- Hazard
- Near Miss / Near Hit
- Defect
- Injury
- Feedback
- Complaint
- Compliment
- Child Safety
Date*
DD slash MM slash YYYY
Time*

: Hours

Minutes

AM/PM
Loco /carriage / trolley #
Train #
Location (i.e. - PBM#, station, level crossing, signal number, building, etc)*
Describe what happened (give information you may consider relevant such as weather conditions, light, body part, direction of car travel, car registration number, etc.)*
What potential contributing factor/s do you believe led to this?*
What action/s did you take?*
Photos (if applicable)
Drop files here or

Max. file size: 512 MB.
DETAILS OF THE INJURED WORKER
Please select the appropriate option IF AN INJURY OCCURED:
- No treatment required
- Applied first aid
- Sought professional medical treatment
Full Name of Injured Worker
Contact Phone Number
Rostered Position (if applicable)
Email Address
This field is hidden when viewing the form
Photos (if required)
Drop files here or

Max. file size: 512 MB.
OTHER PEOPLE / WITNESSES INVOLVED
1) Name
1) Contact Phone Number
1) Rostered Position (if applicable)
1) Email address
2) Name
2) Contact Phone Number
2) Rostered Position (if applicable)
2) Email address
3) Name
3) Contact Phone Number
3) Rostered Position (if applicable)
This field is hidden when viewing the form
3) Name
This field is hidden when viewing the form
3) Contact Phone Number
This field is hidden when viewing the form
3) Rostered Position (if applicable)
3) Email address
Do you need a response to this IDR ?
- Yes
- No
Name of person completing this form
First Last
This field is hidden when viewing the form
Name of person completing this form
Date*
DD slash MM slash YYYY
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Δ

Atsi

Acknowledgement Statement

Puffing Billy Railway acknowledges the Wurundjeri and Bunurong people as the Traditional Custodians of the land on which Puffing Billy Railway operates, and pay our respects to their Elders past, present and emerging.

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We respect and welcome people of all backgrounds, genders, sexualities, abilities, and cultures.

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