Board WHS Report
<insert your logo here>
Reporting Period:
Summary:
<Summarise your organisational performance over the reporting period here, with reference to the areas/sections where your
performance has improved and the areas/sections where your performance required further attention.
You can also highlight outline any
preventative actions you have been taking.>
Category/Section
No. of Incidents
No. of Incidents
Comments
(previous reporting
period)
Section A: Incidents involving Client
Behaviour
Section B: Staff Injuries and
Incidents
Section C: Injuries or Incidents to
Other Workers or Others
Section D: Hazard Reports – No
Incident
Page No 1
NDS Version No:
Board WHS Report
<insert your logo here>
SECTION A: Incidents involving Client Behaviour
Date
Client
initials
Staff
member
initials
Brief description of incident
Describe corrective action taken
Staff
debrief
provided
Y/N
Staff
injury
Y/N
Work
cover
Y/N
Risk
assessment
and controls
Y/N
Reviewed
by H&S
rep Y/N
Date
Staff
debrief
provided
Y/N
Staff
injury
Y/N
Work
cover
Y/N
Risk
assessment
and controls
Y/N
Reviewed
by H&S
rep Y/N
Date
Worker
injury
Y/N
Work
cover
Y/N
Risk
assessment
and controls
Y/N
Reviewed
by H&S
rep Y/N
Date
Total number of incident involving client behaviour =
Total number of incident involving client behaviour for the previous reporting period =
SECTION B: Staff Injuries and Incidents
Date
Staff
member
initials
Brief description of incident
Describe corrective action taken
Total number of injuries/incidents to staff =
Total number of injuries/incidents to staff for the previous reporting period =
SECTION C: Injuries or Incidents to Other Workers or Others
Date
Worker
initials
Brief description of incident
Describe corrective action taken
Worker
debrief
provided
Y/N
Page No 2
NDS Version No:
Board WHS Report
<insert your logo here>
Total number of injuries/accidents to other workers =
Total number of injuries/accidents to other workers for the previous reporting period =
SECTION D: Hazard Reports – No Incident
Date
Worker
initials
Brief description of hazard
Describe corrective action taken
Risk
assessment
and controls
Y/N
Reviewed by
H&S rep Y/N
Date
Total number of hazard reports =
Total number of hazard reports for the previous reporting period =
Signed by:
WH&S representative:
______________________________Date_________
SECTION e: Other Useful Information
Date
Describe main points
Comments
H&S committee meetings held
Work place inspections held
WHS training held
WHS training arranged
WHS Policies/procedures
Page No 3
NDS Version No:
Board WHS Report
<insert your logo here>
developed/reviewed
WHS audit undertaken
General comments (issues highlighted, near misses, concerns, etc):
Page No 4
NDS Version No: