Contractor incident report

Use this page to report any health and safety incident, near misses or hazards encountered while working for us

Please complete this form

Please tell us what happened and when.

Person involved (required)
Who was contractor involved in this incident?

Date of incident (required)

Time of incident (required)

Summary (required)
Please add a one sentence summary of the incident.

Incident description (required)
Please describe the incident in detail.

People involved - if applicable (required)
Please provide details of any members of public or customers who were involved in this incident.

Incident type (required)

Resulted in injury? (required)
Did the incident result in an injury?

Injury type (required)

Prognosis - if applicable (required)
Please provide your injury prognosis and days lost.

Actual consequence (required)

Potential consequence (required)

Cause of incident (required)
Please provide details about the cause or contributing factors leading to this incident.

Immediate actions taken (required)
Please provide details about the immediate actions taken after the incident.

Preventative actions (required)
Please provide details about any preventative actions taken to address the incident.

User code

Tell us who you are as the person reporting this incident.

Name (required)
Name of the person submitting this form.

Email (required)
Email of the person submitting this form.

Phone
A contact phone number for the person submitting this form.

Reported to Enable NZ? (required)
Has the injury been reported to your Enable NZ contact?

By submitting this form, you agree to our privacy policy. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.