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    09 HSE Catatan First Aid Injury

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    ekoimamp
    The document is a first aid record form used to record details of any first aid treatments administered. It collects personal details of the injured person, details of the incident/accident, description of injuries, first aid treatment given, outcome and actions taken. The manager's section checks if the incident was investigated and corrective actions implemented.

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    © All Rights Reserved
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    09 HSE Catatan First Aid Injury

    Uploaded by

    ekoimamp
    24 views1 page
    The document is a first aid record form used to record details of any first aid treatments administered. It collects personal details of the injured person, details of the incident/accident, description of injuries, first aid treatment given, outcome and actions taken. The manager's section checks if the incident was investigated and corrective actions implemented.

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    © © All Rights Reserved

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    The document is a first aid record form used to record details of any first aid treatments administered. It collects personal details of the injured person, details of the incident/accident, description of injuries, first aid treatment given, outcome and actions taken. The manager's section checks if the incident was investigated and corrective actions implemented.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    24 views1 page

    09 HSE Catatan First Aid Injury

    Uploaded by

    ekoimamp
    The document is a first aid record form used to record details of any first aid treatments administered. It collects personal details of the injured person, details of the incident/accident, description of injuries, first aid treatment given, outcome and actions taken. The manager's section checks if the incident was investigated and corrective actions implemented.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    FIRST AID RECORD

    To be completed for all first aid treatments. Original forwarded to the HSE Supervisor at the end of each month

    PERSONAL DETAILS:

    Name:..................................................................... Address:..............................………….............................

    Employer:................................................................ Occupation.…....................................……………..........

    Known Illness including medications:.......................……………...........................D.O.B........../............./.........

    INCIDENT/ACCIDENT DETAILS: INJURY/ILLNESS DETAILS:


    Date/time:.............................................………......…. .............................................................................……..
    Location:........................................................………. ..............................................................................…….
    Work process being performed:.....…….......………..
    .......................................................................………. INCIDENT OUTCOME:
    Description of incident/accident:...................………. FAI  MTI  LTI 
    ……………………………………………………….
    Causes: ..................................................................……
    ………………………………………………………. …………………………………………………………

    FIRST AID TREATMENT:


    .......…............................................………................ (INDICATE LOCATION OF INJURY)

    .................................................................………......

    Date:....../....../......
    __________________________________________
    ACTION: Back to Work 
    Hospital 
    Doctor/Clinic 
    Reported to Supervisor 
    Incident Report Required 

    Name:...........................................................……... MANAGER'S COMMENT:


    (print name of person completing this form) Yes No
    Has incident been investigated?  
    Address:.........................................................…….
    (please print) Has Corrective Action been
    .......................................................................……. implemented?  

    Site Address: ……………………………….……. Has incident investigation report


    ……………………………………………………. been completed?  

    ..............................…………….
    (Signature) ..................................................... ......................
    Signature Date

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