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It records injury type and body location, treatment provided onsite, referral requirements, and injury management actions. The form also documents witnesses, damage to property or equipment, description of the incident, immediate response steps, reporting to required parties and authorities (including SafeWork NSW), and completion details with sign-off.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/whs-form-10-incident-and-injury-report-fill-in-details/248873/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/whs-form-10-incident-and-injury-report-fill-in-details/248873.png","ImageObject",442,249,{"name":88,"@type":89},"supergirl","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required for the injured person section?","Question",{"text":109,"@type":110},"The form collects the injured person’s name, address, occupation, date of birth, telephone, employer, activity at the time of injury, exact site location, and injury nature and body location.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How are treatment and referral details recorded?",{"text":114,"@type":110},"It includes checkboxes for near miss, first aid, and medical treatment/doctor, plus onsite treatment details and whether further referral is required, along with doctor or hospital information and attachments.",{"name":116,"@type":107,"acceptedAnswer":117},"Who and what should be reported after an incident?",{"text":118,"@type":110},"The form captures immediate response actions and whether the incident was reported to the principal contractor, authorities (including SafeWork NSW), and the workers compensation insurer, including required details such as when, to whom, and claim information.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},248873,1789248440,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":126,"read_time":9},962088121634,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","WHS FORM 10: INCIDENT AND INJURY REPORT  \n\n| Details of injury (eg to a worker or visitor) and treatment |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Date of incident |  |  |  |  | Time of incident |  |  | am  pm |  |  |\n| Nature of incident | | Near miss |  | First aid |  |  | Medical treatment/doctor |  |  |  |\n| Name of injured person |  |  |  |  |  |  |  |  |  |  |\n| Address |  |  |  |  |  |  |  |  |  |  |\n| Occupation |  |  |  |  |  |  |  |  |  |  |\n| Date of birth |  |  |  |  |  |  |  |  |  |  |\n| Telephone |  |  |  |  |  |  |  |  |  |  |\n| Employer |  |  |  |  |  |  |  |  |  |  |\n| Activity in which the person was engaged at the time of injury |  |  |  |  |  |  |  |  |  |  |\n| Exact site location where injury occurred |  |  |  |  |  |  |  |  |  |  |\n| Nature of injury – eg fracture, burn, sprain, foreign body in eye |  |  |  |  |  |  |  |  |  |  |\n| Body location of injury (indicate location of injury on the diagram) | |  |  |  |  |  |  |  |  |  |\n| Treatment given onsite |  |  |  |  | Name of treating person |  |  |  |  |  |\n| Referral for further treatment? Yes  No  | Name of doctor or hospital |  |  |  | SafeWork NSW medical certificate received? Yes  No  |  |  | Attach copies |  |  |\n| Injury management requirement? Yes  No  | Notify return to work coordinator |  |  |  | Name of return to work coordinator |  |  |  |  |  |\n\n\n| Witness to incident (each witness may need to provide an account of what happened) |  |  |  |\n| --- | --- | --- | --- |\n| Witness name |  | Witness\u003Cbr>contact |  |\n| Witness name |  | Witness\u003Cbr>contact |  |\n\n\n| Details of incident (eg property, plant or environmental damage) |  |  |  |\n| --- | --- | --- | --- |\n| Date of incident |  | Time of\u003Cbr>incident | am  pm  |\n| Location of incident |  |  |  |\n| Details of damage to equipment or property |  |  |  |\n| Name of person who received the report |  | Telephone |  |\n\n\n| Description of incident |\n| --- |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n\n\n| Immediate response actions (eg barricades, isolation of power) to stabilise the situation |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n| Reported to |  |  |  |  |  |\n| Reported to principal contractor?\u003Cbr>Yes  No  |  |  |  |  | Provide details (when, reported to and reported by): |\n| Reported to authorities\u003Cbr>(SafeWork NSW phone: 13 10 50)? Yes  No  |  |  |  |  | Provide details (when, reported to and reported by): |\n| Reported to principal contractor?\u003Cbr>Yes  No  |  |  |  |  | Provide details (when, reported to and reported by): |\n| Reported to workers compensation insurer?\u003Cbr>Yes  No  |  |  |  |  | Provide details (name of insurer and claim number): |\n\n\n| Completed by |  |  |  |\n| --- | --- | --- | --- |\n| Name |  | Position |  |\n| Signature |  | Date |  |","cbCailzIYntDFdDU","https://ap.wps.com/l/cbCailzIYntDFdDU","pdf",46146,"English","# Incident and injury details\n## Injured person and treatment\n## Incident description and immediate response\n## Reporting and witness information\n## Completion and signatures","[{\"question\":\"What information is required for the injured person section?\",\"answer\":\"The form collects the injured person’s name, address, occupation, date of birth, telephone, employer, activity at the time of injury, exact site location, and injury nature and body location.\"},{\"question\":\"How are treatment and referral details recorded?\",\"answer\":\"It includes checkboxes for near miss, first aid, and medical treatment/doctor, plus onsite treatment details and whether further referral is required, along with doctor or hospital information and attachments.\"},{\"question\":\"Who and what should be reported after an incident?\",\"answer\":\"The form captures immediate response actions and whether the incident was reported to the principal contractor, authorities (including SafeWork NSW), and the workers compensation insurer, including required details such as when, to whom, and claim information.\"}]","WHS Form 10 - Incident and Injury Report - Fill in details | PDF"]