Global Utilities

Incident and Hazard Reporting - La Trobe University

Report New Incident or Identified Hazard

Please complete details and click the Submit button.

Fields marked with a ' * ' are mandatory.

This form is for external submissions, if you are a Student or Staff member of La Trobe University please fill in the report after logging in here.

Incident / Hazard Details
  1. Type: *
  1. : Enter time incident occurred, if known
  2. Include exact location and type of premises (approx 15 words)
  1. What were you doing at the time? How did the incident occur? Describe the hazard (approx 30 words)
  1. Describe the property stolen/lost/damaged (approx 20 words)
Report Submitter Details
  1. Phone


Injured Person Details
  1. Did the Incident cause an injury to any person? *
Injured person personal details
  1. Are you the injured person? Clicking 'Yes' copies the identity data specified above
  1. Injured Staff Email Address:
  1. Gender: *
  2. --
Injured person contact details
  1. Phone




Injury details
  1. (approx 20 words)
  1. Please note: if first aid has been administered a hard-copy of the Record of Treatment must be kept in the department for 7 years.
  1. Has a First Aid Record of Treatment been completed? *

Witnesses
No Given Names Family Name Contact Phone No.
1
2
3