Farra Engineering Health and Safety Portal

Report Injury

Have you seen or been involved in an incident that has caused someone to be injured.

Report Incident

Have you seen or been involved in an incident which could have caused harm to a person, or caused damage to property / environment.

Report Near Miss

Have you seen or been involved in an event that had the potential to cause an injury or an incident. This does not include incidents that caused property damage

Report Risk

Have you observed something that has the potential to cause harm to a person / property / environment.

Record Observation

Record Proactive Safety Observations.

Corrective Action

Update a corrective action that you have been assigned.

Substance Management

Feedback

Give Feedback on Health and Safety Matters.

Instructions: Please complete all fields with as much relevant detail as possible. Once completed, 'Save' the form and the following events will occur:
• You will be given a reference number, save or write this number down for future reference
• An email will be sent to the supervisor of the person involved in the incident

Person Reporting *

Person Reporting Name *

Person Involved *

Person Involved Name *

Sensitive Event *

Event happened offsite

Accountable Company *

-- Please Select -- -- Please Select --

Accountable Department

Location of Event *

Event Date *

Event Time *

Subject *

Category *

Manufacturer *

Supplier *

Client *

Batch Number *

PO Number *

What Happened *

Who Else Was Involved *

What Initial Actions / Corrections Were Taken *

Attach Photo

Event Files

Body Area

The Primary Injury is the most important / critical injury to the person.

Primary	Body Location	Body Area	Injury

Report Observation

Person Reporting *

Person Reporting Name *

Date of Observation *

Time(if applicable)

Category *

Classification *

Accountable Company *

-- Please Select -- -- Please Select --

Accountable Department

Subject *

Observation was Safe/Unsafe

Comments *

Photos/Files

Corrective Action

Responsible By *

Responsible *

Date Assigned *

Date For Completion *

Status *

Status as at *

Action Required *

Action	Person Responsible	Completion Date	Status

Update / Sign Off Corrective Actions

Instructions: Please complete all fields with as much relevant detail as possible. Once completed, 'Save' the form and the following events will occur:
• An email will be sent to both responsible person who will check CA and person responsible who will take action for CA advising a form has been submitted

Webform ID *

Person Reporting Type *

Person Reporting Name *

Status

Status as at

Completion Date

Ref ID

Comment *

Files

Title	Filename	Type

Manage Substance

Action *

Substance *

Checked by Type *

Checked by Name *

Accountable Company *

-- Please Select -- -- Please Select --

Accountable Department

Location *

Storage Method *

Total Quantity *

Checked Date *

Notes *

Attach Photo

Browse

Fields for new substance location(optional)

Supplier

Authorised by Type

Authorised By

Transporter

Arrival Date

Reference