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WHS Form 11 2011-2025 free printable template

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FOR OFFICIAL USE ONLY WHEN FILLED IN Print Form Enterprise IT Services Directorate Request for Data Transfer/Removable Media Approval Instructions Section 1 1. Type of Request 2. Date 3. Requester
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How to fill out WHS Form 11

01
Obtain a blank WHS Form 11 from your local workplace health and safety authority.
02
Enter the date of the incident at the top of the form.
03
Fill in your personal details including your name, address, and contact information.
04
Provide a detailed description of the incident, outlining what happened, when it happened, and where it occurred.
05
List any witnesses to the incident, including their contact information.
06
Note any immediate actions taken following the incident.
07
Sign and date the form to confirm the information is accurate and complete.
08
Submit the completed form to your workplace safety officer or designated authority.

Who needs WHS Form 11?

01
Employees involved in workplace incidents or accidents.
02
Supervisors and managers who oversee the safety practices in the workplace.
03
Workplace health and safety representatives.
04
Health and safety officers tasked with reviewing and investigating incidents.
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WHS Form 11 is a workplace health and safety notification form used to report incidents, hazards, and other safety-related occurrences in the workplace to ensure compliance with safety regulations.
Employers, supervisors, and other designated personnel who oversee workplace safety are required to file WHS Form 11 when an incident or hazard occurs.
To fill out WHS Form 11, gather all relevant information regarding the incident or hazard, including names of affected individuals, details of the event, and any immediate actions taken. Then, complete the form with accurate descriptions and submit it to the appropriate safety authority.
The purpose of WHS Form 11 is to document workplace incidents and hazards to improve safety practices, comply with legal requirements, and prevent future occurrences.
The information that must be reported on WHS Form 11 includes the date and time of the incident, location, description of the incident or hazard, details of those involved, and any corrective actions taken.
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