# NSW WHS Incident Report (Form 10) (https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-10-incident-injury-report) WHS Form 10 records a workplace incident or injury for the Housing Industry Site Safety Pack: when it happened, who was involved, what injury or property damage resulted, what was done immediately, and who was told. The site supervisor or PCBU completes it after people are safe and the scene is under control. The finished PDF is the SafeWork NSW layout for the site file; it does not notify the regulator or the insurer on its own. This is the current SafeWork NSW WHS Form 10 from the Housing Industry Site Safety Pack. Tradie Forms follows the official section order and maps your answers onto the official PDF layout. Updating site hazards after the event rather than writing the incident record? Use [NSW WHS Site Risk Assessment](https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-04-site-specific-risk-assessment) > **Warning** > > This report does not notify SafeWork NSW. For a death, serious injury or illness, or dangerous incident, use the current [SafeWork NSW incident notification](https://www.safework.nsw.gov.au/notify-safework/incident-notification) process. Completing Form 10 is your pack record, not that duty. ## Before you start [#before-you-start] Almost every thin Form 10 comes from reconstructing the day days later instead of capturing facts while they are still clear. Have these ready once immediate care and site safety are handled. - **People safe and the hazard controlled** - Treatment, isolation, and any scene preservation your procedures require before you sit down to write. - **Time, location, and sequence** - When it happened, the exact spot on site, what the person was doing, and the order of events. - **Injured person details** - Name, occupation, contact, employer, date of birth, and home address when you can get them without delaying care. - **Witnesses** - Who saw it, with a number that reaches them later for a separate account. - **Treatment and referrals** - What first aid was given, by whom, and any doctor, hospital, medical certificate, or return-to-work coordinator. - **Who you already told** - Principal contractor, SafeWork NSW, and the workers compensation insurer if any of those were contacted, with times and reference numbers. No field gates the download on this form. Completeness still matters for the site file, the principal, and any later insurer or authority request. ## Injury or Incident [#injury] Records the injured person, when and how the incident happened, the injury, and treatment. Fill this section for near misses, first aid, and medical treatment cases. Write facts, not fault: what happened in order, not who was careless. - **Date of Incident (Date, Optional)** - The calendar day the incident occurred. Today and Yesterday shortcuts are there because this is usually filled the same day or the next morning. The field does not accept a future date. Take it from your phone log or site diary if you are filling later, not from guesswork. - **Time of Incident (Time, Optional)** - The time it happened, as close as you can get, for example `09:30`. Approximate is better than blank when nobody recorded the exact minute; do not invent precision you do not have. - **Nature of Incident (Choice, Optional)** - One of **Near miss**, **First aid**, or **Medical treatment**. Choose the outcome that actually applied. A near miss is the same sequence without the injury; recording it is how the control gets fixed before the next one goes differently. The choice maps to the three tick boxes on page one of the official PDF. - **Name of Injured Person (Text, Optional)** - Full name as they are known on site and on their employment record. For a visitor, use the name they give and note visitor status in **Occupation** or **Employer**. Leave blank only when the report is property damage with no injured person; otherwise the pack has an incident with nobody attached. - **Occupation (Combobox, Optional)** - Their trade or role on the job, such as `Carpenter` or `Site Supervisor`. Common residential trades are offered; you can type a custom value for a visitor, delivery driver, or other role. - **Street address (Address, Optional)** - The injured person's residential address, not the job site. Address search is limited to New South Wales and fills the street line, suburb, state and postcode. Check the result with them when privacy and time allow; do not invent an address to fill the box. - **State (Address, Optional)** - Starts as **NSW**. Confirm it when you type the address by hand or when the person lives interstate. - **Postcode (Address, Optional)** - Filled by address search. Confirm it against what the person or their employer provides when typing manually. - **Date of Birth (Date, Optional)** - From the person or their employer record when you need it for the pack or insurer follow-up. The field does not accept a future date. Skip medical detail beyond what the form asks for. - **Phone (Tel, Optional)** - A number that reaches the injured person for follow-up, for example `0412 345 678`. Prefer their mobile over a shared site phone. - **Employer (Text, Optional)** - The business that employs them on this site, such as `Mitchell Building Pty Ltd`. For your own employee, use your trading name as on Form 01. For a subcontractor worker, name their employer, not only the principal. Who employs them affects who else must be told. - **Activity at Time of Incident (Text, Optional)** - What they were doing in the moment, specific enough that a control can be aimed at it later. Name the task and location context, not a vague trade label. - **Useful** - Carrying wall framing through the northern corridor on level 1 - **Too vague** - Working on site - **Location on Site (Text, Optional)** - The exact spot on the job, not only the street address. On multi-level or multi-lot work this is often the detail that makes the report usable later, for example `Level 1, northern wing` or `Lot 14 rear trench`. - **Nature of Injury (Text, Optional)** - What was hurt, in plain language and without diagnosing, such as `Laceration to left forearm` or `Sprain to right ankle`. The official form examples include fracture, burn, sprain, and foreign body in eye. Describe what you saw and what was treated; leave formal diagnosis to the treating practitioner. - **Body location of injury (Drawing, Optional)** - Mark the injury on the front or rear body diagram in the app. Your marks stamp onto the diagram box on page one of the finished PDF. Use the pen to indicate the area clearly; a blank diagram with a filled nature of injury leaves the pack without a visual location. - **Treatment Given on Site (Text, Optional)** - What first aid or stabilising care was given before anyone left site, for example `Wound cleaned and dressed; arm elevated`. Write the actions taken, not a medical opinion. - **Name of Treating Person (Text, Optional)** - Who gave that on-site treatment, usually a first aider or supervisor, such as `Jordan Lee`. - **Referral for Further Treatment? (Choice, Optional)** - **Yes** or **No**. Answer **Yes** when they were sent to a doctor, medical centre, or hospital after site care. - **Name of Doctor or Hospital (Text, Optional)** - Fill when they were referred, for example `Blacktown Medical Centre` or the hospital name. Leave blank when no further treatment was needed rather than inventing a clinic. - **SafeWork NSW Medical Certificate Received? (Choice, Optional)** - **Yes** or **No**. The form notes to attach copies when applicable. A **Yes** without the certificate filed with the pack is incomplete for anyone following up the claim. - **Injury Management Requirement? (Choice, Optional)** - **Yes** or **No**. The form notes to notify the return to work coordinator when applicable. Answer for this injury, not for the business in general. - **Name of Return to Work Coordinator (Text, Optional)** - Who owns return-to-work for this person when injury management applies, for example `Sam Nguyen`. Fill when the injury management answer is **Yes**, or whenever your system already has a named coordinator. **Saved detail: Injured Person** - save this section to prefill it on your next incident report for the same person. ## Witnesses [#witnesses] Records people who saw the incident. Each row is one witness: name and contact. Talk to witnesses separately and early; accounts converge once people have compared notes. You can add up to **two witnesses**, matching the two name and contact pairs on page one of the official PDF. Leave unused rows out rather than adding blanks. If more people saw it, keep extra statements with the job file and put the two most useful contacts on the form. - **Witnesses (Rows, Optional)** - One row per witness. Each row has **Name** and **Contact Details**. Use a full name and a phone that reaches them later, for example `Jordan Lee` and `0413 456 789`. Contact is a phone field; prefer mobile over a general office number. Two empty rows on a serious injury report look unfinished when a principal or insurer asks who saw it. ## Property Incident [#propertyIncident] Use when the incident involved property, plant, or environmental damage, whether or not anyone was hurt. The official PDF places this block on page two under details of incident. Leave it blank when there was no property damage. - **Date of Incident (Date, Optional)** - The day the property damage occurred. Often the same as the injury date when both happened together. Today and Yesterday shortcuts are available; the field does not accept a future date. - **Time of Incident (Time, Optional)** - When the damage happened, for example `09:35`. Match the injury time when it was the same event, or record the separate time when damage was found later. - **Street address (Address, Optional)** - Location of the incident for the property block. On a residential site this is usually the job address. Address search is limited to New South Wales. Check the result against the site board when the suburb has multiple active lots. - **State (Address, Optional)** - Starts as **NSW**. Confirm when typing by hand. - **Postcode (Address, Optional)** - Filled by address search. Confirm when typing manually. - **Damage to Property (Text, Optional)** - What was damaged and how, factually enough that a principal or insurer can see the asset without standing on site. Name the item and the effect, not only that something broke. - **Useful** - Forklift struck the temporary fence and bent two panels beside the loading area - **Too vague** - Fence damaged - **Name of Person Who Received the Report (Text, Optional)** - Who received or made the property damage report, matching the official wording for the person who received the report, for example `Sam Nguyen`. - **Phone (Tel, Optional)** - How to reach that reporting person, for example `0412 345 678`. ## Description [#description] The free-text account of what happened. This is the field that decides whether the pack can support a real control change later, or only a blame story. - **Description of Incident (Text, Optional)** - The sequence in plain language: what the person was doing, what condition or object was involved, and what happened next. Keep speculation out, or label it clearly. An account that only concludes someone was not paying attention stops the investigation at the person and never reaches the condition that let it happen. - **Useful** - While carrying wall framing, the worker caught their forearm on a protruding metal edge and sustained a cut - **Too vague** - Worker was not paying attention ## Immediate Actions [#immediateActions] What was done straight after the event to stabilise people and the site. The official form examples include barricades and isolation of power. - **Immediate Actions Taken (Text, Optional)** - The response steps in order: first aid, making the area safe, who was told on site, and any temporary control left in place. Write what was done, not what you wish had been done. - **Useful** - First aid applied on site. Area cordoned off and nail plate removed. Supervisor notified - **Too vague** - Dealt with ## Reported To [#reporting] Three reporting channels on the official form: principal contractor, authorities (SafeWork NSW), and the workers compensation insurer. Each has a yes or no choice and a details box for when, who was told, and who made the report. This section records whether those parties were told. It does not perform the notification. Where SafeWork NSW notification is required, follow the current [incident notification](https://www.safework.nsw.gov.au/notify-safework/incident-notification) process; the form shows SafeWork NSW phone **13 10 50**. Do not delay a required notification while finishing this PDF. - **Reported to Principal Contractor? (Choice, Optional)** - **Yes** or **No**. Answer for this incident. On most residential sites the builder or principal expects to hear promptly when someone is hurt or plant is damaged. - **Provide Details (When, Reported To and Reported By) (Text, Optional)** - For the principal contractor line: when they were told, who received the report, and who made it, for example `Site supervisor notified immediately on 15 June 2026 by Sam Nguyen`. Leave blank when the answer above is **No**. - **Reported to Authorities (SafeWork NSW Phone: 13 10 50)? (Choice, Optional)** - **Yes** or **No**. This is a record of whether SafeWork NSW was contacted for this incident. A **Yes** without a real notification is worse than **No**, because the pack then claims a report that never happened. Check current notification requirements before assuming the incident is notifiable. - **Provide Details (When, Reported To and Reported By) (Text, Optional)** - For the authorities line: time, who called, and any reference SafeWork NSW gave you, for example `SafeWork NSW notified by Sam Nguyen at 10:45 am on 15 June 2026. Reference SW-260615`. - **Reported to Workers Compensation Insurer? (Choice, Optional)** - **Yes** or **No**. Answer when a worker injury may involve a claim or your insurer requires early notice. Policy and claim rules sit with the insurer and your workers compensation arrangements, not with this page. - **Provide Details (When, Reported To and Reported By) (Text, Optional)** - For the insurer line: who notified them, when, and any claim or incident reference, for example `Insurer notified by Sam Nguyen at 11:10 am on 15 June 2026. Claim reference WC-260615`. ## Completed By [#completedBy] Who wrote this report and when. An account with no author is hard to follow up when questions arrive weeks later. - **Name (Text, Optional)** - The person completing the report, usually the supervisor or the person managing the site that day, for example `Sam Nguyen`. Match the name people on site would recognise. - **Position (Combobox, Optional)** - Their role, such as `Site Supervisor` or `WHS Officer`. Common site roles are offered; type a custom value when needed. - **Signature (Signature, Optional)** - Sign when the facts above are correct for this incident, not as a blank template for later jobs. You can use a saved signature; check the preview so the stamp sits cleanly in the signature box on page two. - **Date (Date, Optional)** - The date this report is completed. Today and Yesterday shortcuts are available. The field does not accept a future date. Prefer the day of the incident or the next morning over a week-later reconstruction. **Saved detail: Completed By** - save this section to prefill it on your next incident report you complete. ## Common mistakes [#common-mistakes] - **Treating Form 10 as SafeWork NSW notification.** - The pack record and the regulator duty are separate. Completing this PDF does not tell SafeWork NSW anything. Use the current incident notification process when the incident is notifiable. - **Writing fault instead of sequence.** - Lines such as "not paying attention" stop the review at the person. Describe what they were doing, what condition was present, and what happened next so a control can be fixed. - **Leaving location as the street address only.** - Multi-level and multi-lot sites need the exact spot. Without it, photos and statements cannot be matched to the place later. - **Skipping near misses because nobody was hurt.** - A near miss is the same event with a better outcome. Recording it is how the control changes before the next person is injured. - **Marking Yes for authorities or insurer without a real contact.** - The details box should show when, who reported, and who was told. A bare Yes with empty details looks like a box ticked for appearance. - **Leaving the body diagram blank when an injury is named.** - Nature of injury without a mark on the diagram leaves page one incomplete. Mark the front or rear view in the app so it stamps onto the PDF. - **Editing the original account days later without a dated addition.** - Correct facts as a dated note that says what changed and why, and keep the first version with the file. Quiet rewrites undermine trust in the record. - **Filing the report and never changing Form 04 or Form 06.** - The value of the report is the control that follows. Put the condition back into the site risk assessment and cover the change at the next toolbox talk. ## Before download [#before-download] - Date, time, and nature of incident match what actually happened - Injured person, occupation, employer, and location on site are specific enough to follow up - Nature of injury and body diagram agree, or the diagram is blank only because there was no injury - Description and immediate actions are a fact sequence, not a blame conclusion - Witness rows name real people with reachable contacts, or are left empty rather than padded - Property damage is filled only when plant, equipment, or property was damaged - Principal, authority, and insurer answers match real contacts, with when and who in the details boxes - Completed by name, position, signature, and date are filled, and the PDF preview matches the pack layout ## After download [#after-download] Keep the finished PDF in the site safety file for that job and retain a copy with your business records. Tradie Forms does not lodge Form 10 with SafeWork NSW, the workers compensation insurer, or the principal contractor. - **Name the file with the person or site and the date** so it sits with the rest of the HIISP pack, for example `WHS-10 - Alex Chen - 2026-06-15.pdf`. - **File photographs and statements with it.** The report alone is harder to use later without scene photos, witness notes, and any medical certificate copies the form says to attach. - **Complete any required notifications separately.** Principal, SafeWork NSW, and insurer notice are outside this PDF. Check the current [SafeWork NSW incident notification](https://www.safework.nsw.gov.au/notify-safework/incident-notification) guidance for your incident type. - **Close the loop on controls.** Update the [site-specific risk assessment](https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-04-site-specific-risk-assessment) when a condition allowed the incident, and cover the change at the next [toolbox talk](https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-06-toolbox-talk-record). - **Do not quietly rewrite the original.** Add dated corrections rather than replacing the first account once copies have gone out. Check the current SafeWork NSW Housing Industry Site Safety Pack and incident notification requirements for your job. What the principal requires on that site sits with the principal and the authority, not with this page. ## Related guides [#related-guides] - **[NSW WHS Site Risk Assessment (Form 04)](https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-04-site-specific-risk-assessment)** - Put the condition that allowed the incident back into the site hazard controls. - **[NSW WHS Toolbox Talk Record (Form 06)](https://dev.tradieforms.com.au/docs/form-guides/building/nsw/nsw-safework-whs-06-toolbox-talk-record)** - Record the crew talk once the control change is ready to share on site. - **[HIISP site pack overview](https://dev.tradieforms.com.au/resources/nsw-whs-site-pack-swms-risk-assessment-toolbox)** - How Forms 04, 05 and 06 work together, and where the incident record sits in the pack.