Accident/incident report form

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Information status

All documents issued prior to 1 July 2017 were issued by the former Department of Commerce. Documents listed here are the latest versions available, but may be subject to review. For more information on this document, please contact online@dmirs.wa.gov.au.

This publication is for: 
Employee / workerEmployer

Sample form for your own use to report accidents or incidents. 

WorkSafe
Template
Last updated 21 May 2014

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