WHS Form 10
Download the checklist as a PDF or as an excel file (Scroll down the page).
What's in the WHS Form 10?
| Injured Person Name | Text |
| Injured Person DOB | Text |
| Department | Text |
| Workers Address | Text |
| Manager | Text |
| Date/Time of injury | Text |
| Nature of injury | Text |
| Body location | Text |
| Location at time of injury | Text |
| How was the injury sustained? | Text |
| Was any plant, equipment, substance or other thing involved? Provide details. | Text |
| Were there any witnesses? | Yes/No |
| Has the injury been reported to the worker's supervisor? | Yes/No |
| Was any treatment provided? | Yes/No |
| Did the injured worker return to work following the injury? | Yes/No |
| Reporter Name | Text |
| Reporter Department | Text |
| Reporter Signature | Signature |
Get the Printable WHS Form 10:
- Download the Printable WHS Form 10 as a PDF file -
WHS Form 10.pdf - Download the Printable WHS Form 10 as an Excel file -
WHS Form 10.xls - View the WHS Form 10 as a webpage -
WHS Form 10.html - Print a WHS Form 10 QR Code -
WHS Form 10.qrcode
Questions?
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