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Overview
Complete
23 Oct 2018 / 3241 / Zico / Howard Mann
OSHA Form 301
Failed items
0
Created actions
0
Case No.
3241
Employee Name (Optional)
Howard Mann
Establishment name
Zico
Conducted on

23rd Oct, 2018

10:40 AM +08

Prepared by
John Smith
Audit
Information about the employee
Full name
Howard Mann
Address
32 Brock Street, Kingsford 2032 Sydney Australia
Date of birth

5th Oct, 1998

Date hired

4th Sep, 2018

Gender
Male
Information about the physician or other health care professional
Name of physician or other health care professional
Edward Wong
Was treatment given away from the worksite?
No
Notes
Paramedic ambulance was called to the worksite
Was employee treated in an emergency room?
No
Was employee hospitalized overnight as an in-patient?
No
Notes
Treatment was given onsite by paramedic
Information about the case
Case number from the log
3241
Date of injury or illness

22nd Oct, 2018

Time employee began work

22nd Oct, 2018

8:00 AM +08

Estimated time of event (leave blank if time cannot be determined)

22nd Oct, 2018

11:00 AM +08

What was the employee doing before the incident occurred? Describe the activity, as well as the tools, equipment or material the employee was using.
Climbing a ladder while carrying roofing materials
What happened? Tell us how the the injury occurred.
When ladder slipped on wet floor, worker fell from top rung approximately 2 metres. Paramedic was called on the scene to inspect injury and identified it as a serious ankle sprain. A temporary leg strap was available onsite and provided to Howard to use.
Type of incident
Injury
Describe the injury or illness? Tell us the part of the body that was affected and how it was affected
Sprained ankle
What object or substance directly harmed the employee?
Concrete floor from falling from ladder
Upload photos of the incident
Photos
Did the employee die?
No
Completion
Observations and comments
Supervisor and team have been notified to inspect wet floors before setting up ladders. An email was sent company wide reminding other teams of the dangers of setting up ladders during we weather conditions.
Full Name and Signature of Record Keeper
John Smith
23rd Oct, 2018 11:05 AM +08
Photos