Whsmp · OPW16/0021

                                                                     Critical Response Checklist
                                                                                       HB-HSEQ-F-027-D
                                                                                              Version:5




PROJECT NAME:

LOCATION:

CRITICAL INCIDENT DESCRIPTION:




DATE:

TIME OF INCIDENT:

                                                                                          DATE &
            ITEM                 YES   NO            FURTHER ACTION/COMMENTS
                                                                                           TIME
                                                Team Leader:
Has the Critical Response Team                  Managing Director:
been assembled and                              Safety Manager:
informed?
                                                Rehab & Return to Work Coordinator:
                                                Finance Manager:

Have Directors been notified?

Have client / client
representative been notified?

                                            How?
Has the area been secured?

Has next of kin been informed,
if applicable?

Have contact details for all
affected personnel been
collected and made available?

Have Emergency Services been                If Yes, who?
contacted?

Has a liaison with Emergency
Services been appointed?
Has the Work Health and
Safety Regulator been
notified?




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