Health & Safety Incident / Near Miss Report
Please use this form to report an accident, injury, illness, incident or near miss that occurs during an EPIC Te Puke event or activity.
If there is an immediate risk to health or safety, please notify an EPIC event representative immediately. In an emergency, call 111.
Please provide as much information as you can. If you don't know the answer to a question, you can leave it blank unless marked as required.
Please include as much detail as possible.
Person(s) Involved
Please provide details for anyone directly involved in the incident. Click Add Another Person if more than one person was involved.
Please include as much information as possible.
Please complete this section where an incident has resulted in injury or an illness has occured.
Please ensure an EPIC event representative has been made aware of the risk immediately.
Please note, information submitted through this form will be used by EPIC Te Puke for health and safety management, incident investigation and follow-up, and to meet any legal or regulatory obligations that may apply.
