Register of Injuries Illness Template - Free Download
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Register of injuries / illness- Template
Employers are required to keep a register of injuries that is readily accessible in the workplace
(Under Section 63 of the Workplace Injury Management and Workers Compensation Act 1998).
The manager of any mine or quarry, or the occupier of any factory, workshop, office or shop is
responsible for this register of injuries.
Requirements of injury and illness registration
Employers must keep a Register of Injuries at each workplace for workers to record any
workplace injury or illness
The register of injuries may be kept in electronic form only if the employer provides education,
training and facilities to ensure that workers are able to access the register.
An injured worker (or someone acting on their behalf) must notify the employer in writing, or
verbally, of any work-related injury or illness as soon as possible after an injury has happened
Employers need to provide written confirmation to the injured worker that they received
notification of the injury or illness
Employers need to provide a signed and dated copy of this entry to the injured or ill worker.
(INSERT YOUR BUSINESS NAME HERE)
(INSERT NATURE OF BUSINESS / INDUSTRY)
Injured / ill worker’s details
First name: Last name: Date of birth:
Volunteers: Worker’s address:
Injury or illness details
Date of injury/illness: Time of injury/illness: am/pm
Nature of injury/illness:
Bodily location of injury/illness (for illnesses include symptoms):
Catalogue No. WC03743 0512 ISBN: 978-1-74341-073-8 Page 1 of 3