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First Aid Report Form

report of aid

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Wasim Akram
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13 views

First Aid Report Form

report of aid

Uploaded by

Wasim Akram
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INSTRUCTIONS FOR COMPLETING THE FIRST AID REPORT FORM

1. Print out the First Aid Report Form.

2. Complete all the details required including the name of any witnesses.

4. Ensure the form has been signed and dated by you.

5. Place the completed form in a sealed envelope and mark it “confidential.”

6. Send (via internal mail) to:

Occupational Health Nurse Consultant


Occupational Health and Safety
30 Research Way Clayton Campus

Please note an online Hazard and Incident Reporting Form may be required to be completed (via
S.A.R.A.H.). Ideally, the casualty should be encouraged to complete the online form as soon as they are
well enough. The attending First Aider can delegate this task to another party (e.g. the injured person; a
supervisor; a witness). Staff and students are able, and encouraged, to access the system via the
my.monash portal and OH&S unit website.

Please call one of the Occupational Health Nurse Consultants at Occupational Health and Safety on
9905 1014 if you have any queries regarding completing the First Aid Report Form.

Requests for further information and all enquiries regarding the S.A.R.A.H. can be directed to the OH&S
unit via [email protected]

Monash University First Aid Report Form v 4. 2 Responsible Officer: Manager, OH&S Page 1 of 3
Date of first issue: July 2003 Date of last review: August 2021 Date of next review: 2024

For the latest version of this document please go to: http://www.monash.edu.au/ohs/


Monash University First Aid Report Form
This is a confidential document and should be sent directly to Occupational Health Nurse.
THE
OCC
UPAT
Date of injury: Time of injury: IONA
Hazard & Incident Form completed:  Yes  No Incident No: L
SECTION 1: CASUALTY INFORMATION

Name of injured person: Sex: Male Female


Home Address:
Suburb: Postcode:
Mobile: Home: Work:
Date of birth: Occupation:
(Please ✓)  Student  Staff  Visitor  Contractor
SECTION 2: INJURY DETAILS

Location injury occurred: (e.g. Building 11, stairwell outside room 419)

Nature of injury: (e.g. metal grinding; dust in right eye etc.) Be specific. State which part of body affected e.g.: right/left/indicate finger etc.

How injury occurred: (whilst cutting metal with angle grinder)

Type of injury Cause of Injury


Asthma Collision
Bleeding Contact
Breathing Entrapment
Bruising Exposure
Burns Fall
Electric shock Lifting
Fainting Reaching
Head injury Slip
Illness Struck
Irritation Submersion
Laceration Other (specify:
Pain
Puncture
Seizure
Sunburn
Unconsciousness
Other (specify): LOCATION ON BODY (Circle injured area):

Monash University First Aid Report Form v 4. 2 Responsible Officer: Manager, OH&S Page 2 of 3
Date of first issue: July 2003 Date of last review: August 2021 Date of next review: 2024

For the latest version of this document please go to: http://www.monash.edu.au/ohs/


Treatment details: (e.g. treatment, products used, time periods, cleaned, iced etc.)

Outcomes: e.g. returned to work; went home; advised to see own doctor/specialist; referred to hospital; referred to Monash
University Health Services; ambulance called.

Witness name:
Witness telephone no.:
Treated by:
Department:
Telephone no.:
Date report completed:
Name of person reporting incident:
Contact details:

Privacy Statement

The information on this form is collected for the primary purpose of providing high quality health care. It may also be used for a related
secondary purpose that complies with legislative reporting requirements. The information collected on this form may be disclosed to
others involved in your health care and government departments such as the Department of Human Services as required under
mandatory reporting requirements. If all of the information requested is not provided, it may compromise the quality of the health care
and treatment given to you, and may not be possible for the university to meet its legal obligations. You have a right to access personal
information that Monash University holds about you, subject to any exceptions in relevant legislation. To do this, please contact the
Monash University Privacy Officer at [email protected].

Monash University First Aid Report Form v 4. 2 Responsible Officer: Manager, OH&S Page 3 of 3
Date of first issue: July 2003 Date of last review: August 2021 Date of next review: 2024

For the latest version of this document please go to: http://www.monash.edu.au/ohs/

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