Incident

Fields	Field Explanation
Number	Automatically generated with the following format : HSEXXXX where XXXX is the next sequential number and YY is the current year.
Type	Allow selection from ‘Environment’, ‘Fire’, ‘Injury / Illness’, ‘Near Miss’, ‘Natural Disaster’, ‘Vehicle / Traffic’, ‘Security’ and ‘Other’. To be set by default with ‘Injury / Illness’ when a new record is created.
Site/Facility	Allow selection from Adelaide Office Adelaide Warehouse Brisbane Office Brisbane Warehouse Hobart Office Hobart Warehouse Melbourne Office Melbourne Warehouse Newcastle Office Newcastle Warehouse Perth Office Perth Warehouse Sydney Office Sydney Warehouse Townsville Office Townsville Warehouse
Incident Date and Time	Allow selection of a date and time. To be set by default with the current date and time.
Incident Title	Allow free text entry. Mandatory field.
Locations where event occurred	Allow free text entry.
Detailed Description of Incident	Allow free text entry.
What task was being performed at that time?	Allow free text entry. Only shown when Incident Type = Other
Was the activity part of normal duties?	Allow Selection from Yes or No. Only shown when Incident Type = Other
Were any Hazards identified during the course of incident?	Allow Selection from Yes or No. Only shown when Incident Type = Other
What immediate or temporary controls where implemented at the time?	Allow free text entry. Only shown when Incident Type = Other
Did the incident cause damage to property?	Allow Selection from Yes or No. Only shown when Incident Type = Other
Was there any additional damage or loss?	Allow Selection from Yes or No. Only shown when Incident Type = Other
Did this situation have the potential to harm the environment?	Allow Selection from Yes or No. Only shown when Incident Type = Other
Did this situation have the potential to harm other employees?	Allow Selection from Yes or No. Only shown when Incident Type = Other
Was there any witness to the incident?	Allow Selection from Yes or No.
Are there security cameras at the site?	Allow selection from Yes or No. If ‘Was there any witness to the incident’, selected as Yes then this field will be visible.
Was the incident recorded and retained on the video?	Allow selection from Yes or No. If ‘Are there security cameras at the site?’, selected as Yes then this field will be visible.
Video Attachment	Allow file selection. If ‘Was the incident recorded and retained on the video’, selected as Yes then this field will be visible.
Attachment	Allow user to attach files.
Incident Image	Allow user to attach and annotate the image.

Fields	Field Explanation
Reporter Type	Allow selection from ‘Internal Employee’, ‘Contractor’, ‘External’, ‘Other’, 'Visitor'
Reported By	Allow free text entry.
Contact Details	Allow free text entry.

Fields	Field Explanation
Type	Allow selection from ‘Employee’, ‘Contractor’ and ‘Visitor’.
Employee Name	Allow free text entry.
Contact Details	Allow free text entry.
Comments	Allow free text entry.
Person Involved Condition	Allow selection from ‘Injured’, ‘Suffered Incident’, ‘Suffered Incident’, ‘Suffered Illness’, ‘Fatality’, and ‘Other’.
Level of Treatment	Allow selection from ‘First Aid’, ‘Medical Treatment (General Practitioner)’, ‘Medical Treatment (Special Practitioner)’, ‘Hospitalisation’

Fields	Field Explanation
Investigation Team Required?	Allow user to specify whether an investigation team will be required
Investigator	Allows selection from Users and Groups, this field is automatically set based on the Site / Facility. The Investigator is assigned to the Investigation step of the Workflow
Approver	Allows selection from Users and Groups The Approver is assigned to the Approval step of the Workflow
Verifier	Allows selection from Users and Groups The Verifier is assigned to the Verify step of the Workflow
Internal Team Member	Allow selection from all available users in the system
External Team Member	Allow free text entry
Incident Confidential?	Displayed if ‘Investigation Team Required?’ is set.
Incident Record Visible to	Displayed if ‘Incident Confidential?’ is set. Allow selection from all available users in the system . Incident shall only be visible to the selected users in this field, the assigned users of the incident and Super Users.

Fields	Field Explanation
Show Body Map	Allow user to specify whether the injuries shall be displayed on an image.

Fields	Field Explanation
Markup	Shall display a body map. Allow user to add markup to the body map.

Fields	Field Explanation
Employment Type	Allow selection from ‘Internal Employee’, ‘Contractor’, ‘External’, 'Visitor'
Name	Allow free text entry.
Job Title	Allow free text entry.
Contracting Company	Allow free text entry.
Date Hired	Allow selection of a date from calendar.
Date of Birth	Allow selection of a date from calendar.
Gender	Allow selection from ‘Male’ and ‘Female’
Employee ID#	Allow free text entry.
Address	Allow free text entry.
Phone #1	Allow free text entry.
Phone#2	Allow free text entry.
Email	Allow free text entry.

Field	Field Explanation
Classification	Allow selection from Injury, Skin Disorder, Respiratory Condition, Poisoning, Hearing Loss and Other
Mechanism of Injury	Allow selection from: Falls from a height Falls on the same level (including trips and slips) Hitting objects with a part of the body Exposure to mechanical vibration Being hit by moving objects Exposure to sharp sudden sound Long term exposure to sounds Exposure to variations in pressure (other than sound) Repetitive movement with low muscle loading Other muscular stress Contact with electricity Contact or exposure to heat and cold Exposure to radiation Single contact with chemical or substance (excludes insect and spider bites and stings) Long term contact with chemical or substance Other contact with chemical or substance (includes insect and spider bites and stings) Contact with, or exposure to, biological factors Exposure to mental stress factors Slide or cave-in Vehicle accident Other and multiple mechanisms of injury Unspecified mechanisms of injury
Type	Allow selection from: Fractures (excluding of vertebral column) Fracture of vertebral column with or without mention of spinal cord lesion Dislocations Sprains and strains of joints and adjacent muscles (include acute trauma sprains and Intracranial injury, including concussion Internal injury of chest abdomen and pelvis Traumatic amputation, including enucleation of eye (loss of eyeball) Open wound not involving traumatic amputation Superficial injury Contusion with intact skin surface and crushing injury, excluding those with fracture Foreign body on external eye, in ear or nose or in respiratory, digestive or reproduc Burns Injuries to nerves and spinal cord without evidence of spinal bone injury Poisoning and toxic effects of substances Effects of weather, exposure, air pressure and other external causes not elsewhere cl ectrocution) Multiple injuries (only to be used where no principal injury can be identified) Damage to artificial aids Other and unspecified injuries Deafness Eye disorders (non-traumatic) Other diseases of the nervous system and sense organs Disorders of muscle, tendons and other soft tissues (includes synovitis, tenosynoviti Other diseases of the musculoskeletal system and connective tissue Dermatitis and other eczema Other diseases of skin and subcutaneous tissue Hernia Other diseases of the digestive system Infectious and parasitic diseases Diseases of the respiratory system (include asthma, legionnaires disease, asbestosis, Diseases of the circulatory system (include heart disease, hypertension, hypotension, Cancers and other neoplasms Mental disorders Other diseases
Severity	Allow selection from Disease, Fatality, First Aid, Medical Treatment and Other.
Bodily Location	Allow selection from: Eye Ear Face Head (other than eye, ear and face) Neck Back Trunk (other than back and excluding Shoulders and arms Hands and fingers Hips and legs Feet and toes Internal organs (located in the trun Multiple locations (more than one of General and unspecified locations
Side	Allow selection from Left, Right, Lower, Upper, Second, Third, Fourth.
Type of Contact	Allow selection from Caught between, Chemical, Cold environment, Cold Surface, Electricity, Mobile equipment and Noise.
Source of Contact	Allow selection from Movement, Buildings / Structures, Doors and Handling of material/equipment.
How did the injury occur	Allow free text entry.
What was the person doing at a time?	Allow free text entry
What happened unexpectedly?	Allow free text entry
How exactly was the injury or illness sustained?	Allow free text entry
Was the incident caused by a Hazard?	Allow selection from Yes or No
CREATE HAZARD	Creates a record in the Hazard Module
Did the Incident cause damage property?	Allow selection from Yes or No
What property was damaged and how?	Allow free text entry if the selection above is Yes
What immediate or temporary controls were implemented at the time?	Allow free text entry
Was there any additional loss or damage?	Allow free text entry
What additional loss or damage was there?	Allow free text entry if the selection above is Yes
Did this situation have the potential to harm the environment?	Allow selection from Yes or No
How could the situation have potentially harmed the environment?	Allow free text entry if selection above is Yes

Field	Field Explanation
Name of physician or other health care professional	Allow free text entry.
Treatment conducted in another Facility	Allow selection from 'Yes' or 'No'.
Was employee hospitalized?	Allow selection from 'Yes' or 'No'.
Was employee treated in an emergency room?	Allow selection from 'Yes' or 'No'.
Absence from Work?	Allow user to specify whether there was any absence from work.
Facility	Displayed if ‘Was employee treated in an emergency room?’ is set to ‘Yes’. Allow free text entry.
Address	Displayed if ‘Was employee treated in an emergency room?’ is set to ‘Yes’. Allow free text entry.
Job Transfer/Restriction?	Allow user to specify whether there was any Job Transfer or Restrictions

Field	Field Explanation
Environment Incident Type	Allow selection from Breach of license condition, Chemical spill, Damage to culture heritage internal area, Excessive noise, excessive vegetation clearance or damage, fauna injury, fire explosion, fuel spill, management of wastes, protected vegetation damage, uncontrolled air emission, water release (muddy, contaminated).
Agencies Involved	Allow selection from EPA, Fire Authority, Other, Police, RSPCA, Water Authoring.
Effects	Allow selection from Archaeology, heritage or cultural issue; Contamination of land,;Controlled and uncontrolled discharges to water; controlled and uncontrolled emissions to atmosphere; effects on the natural environment; legal; Noise,dust vibration and odour; Other(General environment and social effects); public/media; solids and other wastes; use of land, water, fuels and energy, and other natural resources.
Reports Required	Allow selection from Option 1, Option 2, Option 3.
Amount of substance	Allow free text entry.
Unit of substance	Allow selection from these units cl, g, ml, cm, ghz, mm, cu cm, gl, psi, cu ft, hz, pa, cu inch, inch, oz, cu m, kg, radians, cu mm, khz, ton, deg c, mg, %, deg f, m, each, fl oz, mhz, ft, micron.
Incident Duration (hrs)	Allow free text entry.
Cleanup (hrs)	Allow free text entry.

Field	Field Explanation
Registration Number	Allow free text entry.
Vehicle Incident Type	Allow selection from single car, multi car.
Vehicle Type	Allow selection from Personal Car, Company Car.
Additional Details	Allow free text entry.

Field	Field Explanation
Type	Allow selection from Contractor, External, Internal Employee and Other.
Name	Allow free text entry.
Contact Details	Allow free text entry.
Comments	Allow free text entry.
Statement	Allow free text entry.

Field	Field Explanation
Incident Severity	Allow selection from Catastrophic, Extreme, High and Low
Potential Breach of Safety Rules	Allow selection from Yes or No
Is this Incident Reportable	Allow selection from Yes or No
Conduct Risk Assessment	Allow user to specify whether Risk Assessment is required or not.

Field	Field Explanation
Date and Time	Allow user to specify a date and time.
Who	Allow free text entry.
What	Allow free text entry.
Why	Allow free text entry.

Field

Field Explanation

Has Incident Cause been determined?

Allow user to determine if the incident cause has been determined

Attachments

Allow user to attach a file.

Immediate Cause

Allow user to select multiple values from the following drill down options. Displayed if Has incident Cause been determined? is set
The available options can be summed up in the table below

Personal : Body position : Ascending/Descending	Personal : Improper use of PPE	Environment : Inadequate ventilation
Personal : Body position : Eyes of path	Personal : Operating or working at unsafe speed	Environment : Poor housekeeping
Personal : Body position : Line of fire	Equipment : Defective tools or equipment	Environment : Radiation exposure
Personal : Body position : Grip/force	Equipment : Hazard identification inadequate or absent	Organisation : Inadequate engineering
Personal : Body position : Posture	Equipment : Improper or defective PPE	Organisation : Inadequate leadership or supervision
Personal : Body position : Pushing & Pulling	Equipment : Inadequate protective mechanisms or guards	Organisation : Inadequate purchasing
Personal : Failure to follow confined space procedure	Equipment : Toxic materials	Organisation : Inadequate rules
Personal : Failure to follow standard operating procedure	Equipment : Tool or equipment not available or inadequate	Organisation : Inadequate tools or equipment
Personal : Failure to warn	Environment : Air contaminants	Organisation : Inadequate work standards
Personal : Failure to wear PPE	Environment : Excessive noise	Organisation : Lack of communication
Personal : Improper use of equipment	Environment : Inadequate illumination
Personal : Improper use of hand tools	Environment : Improper arrangement of materials and equipment

Secondary Cause

Allow user to select multiple values from the Immediate Causes list of options.
Displayed if Has incident Cause been determined? is set

Additional Details

Allow free text entry.
Displayed if Has incident Cause been determined? is set

Lessons Learnt

Allow free text entry.
Displayed if Has incident Cause been determined? is set

Field	Field Explanation
Actions Required?	Allow user to determine if the incident cause has been determined
ACTION PLAN	A button that triggers the action dialog to allow planning actions.
START ALL ACTION	A button that allows starting all planned actions.

Field	Field Explanation
Item	Free text field. Multiple Items can be specified.
Cost	Currency field. For each item specified, a cost can be specified.

Field	Field Explanation
Incident actions completed as planned	Allow selection from Yes or No.
Additional Details	Allow free text entry.

Momentum QMS Help

Incident

Incident Overview Diagram

Incident Form Sections