Whsmp · OPW16/0021

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


                                                                                            DATE &
             ITEM                 YES   NO            FURTHER ACTION/COMMENTS
                                                                                             TIME
Has an Incident Report (HB-
HSEQ-F-027-B) and Injury /
Incident Statement Form (HB-
HSEQ-F-027-C) been collected?

Has a media liaison been                     If Yes, Who?
appointed and all site staff
informed of redirection of any
enquiries?

Counselling and Support                      Converge International – 1300 855 039
Services notified and offered
to relevant persons?
                                             If Yes, which insurers…
Has HB insurance provider
been notified of potential
claims?

Is Industry representation
required and have they been
notified?
Has all documentation been
collated and seized for release
to appropriate authorities?
Is Legal Representation
required and/or notified?

Other:


Other:



Comments:




Form Completed By:

Signature




                                                                                             Page 2 of 2