Health and Safety at Work (Mining Operations and Quarrying Operations) Regulations 2016

Schedule 6 Particulars of notifiable events

r 226(1), (2)

1 Particulars of mining operation
(1)

Mining operation: [include location]

(2)

Particulars of mining operator: [name, business address, telephone number, and email address]

(3)

Particulars of site senior executive: [name, business address, telephone number, and email address]

2 Description of notifiable event
(1)

Where and how did the notifiable event occur? [describe the events leading up to the notifiable event]

(2)

Has an investigation been carried out? Yes/No

(3)

Describe any hazards involved:

(4)

Were any of the hazards a principal hazard? Yes/No

(5)

Identify the hazards that were principal hazards:

3 Particulars of notifiable event
(1)

Location within mining operation where notifiable event occurred:

(2)

Time and date of notifiable event:

(3)

Shift: [select 1 of the following:

  • day

  • afternoon

  • night]

(4)

Hours worked since arrival at work (if notifiable event involves a worker):

(5)

Description of any plant involved in notifiable event: [include make and model]

(6)

Type of notifiable injury or illness or fatality (if applicable): [indicate the type of notifiable injury or illness or fatality]

(7)

Name of injured person or deceased person (if any):

(8)

Was a notifiable event involved? Yes/No

4 Additional particulars required in cases of notifiable injury or illness or fatality

Particulars of affected person

(1)

Residential address:

(2)

Date of birth:

(3)

Sex:

(4)

Occupation or job title:

(5)

Self-employed: Yes/No

(6)

Employer:

(7)

Period of employment (employees only): [select 1 of the following:

  • first week

  • first month

  • 1–6 months

  • 6 months–1 year

  • 1–5 years

  • over 5 years]

Particulars of injury (if any)

(8)

Treatment: [select 1 of the following:

  • none

  • first aid only

  • doctor but no hospitalisation

  • hospitalisation]

(9)

Body part affected: [select 1 or more of the following:

  • head

  • neck

  • trunk

  • upper limb

  • lower limb

  • multiple locations

  • systemic internal organs]

(10)

Nature of notifiable injury or illness (if applicable) or cause of notifiable incident (if fatality): [select 1 or more of the following:

  • spine fracture

  • fracture other than spine fracture

  • dislocation

  • sprain or strain

  • head injury

  • internal injury of trunk

  • amputation (including eye)

  • open wound

  • superficial injury

  • bruising or crushing

  • foreign body

  • burns

  • nerves or spinal cord

  • multiple injuries

  • puncture wound

  • poisoning or toxic effects

  • damage to artificial aid

  • disease, nervous system

  • disease, musculoskeletal system

  • disease, skin

  • disease, digestive system

  • disease, infectious or parasitic

  • disease, respiratory system

  • disease, circulatory system

  • tumour (malignant or benign)

  • mental disorder]

Further particulars of notifiable event

(11)

Mechanism of notifiable injury or illness (if applicable) or notifiable incident (if fatality): [select 1 or more of the following:

  • fall, trip, or slip

  • animal, human, biological agency (other than bacteria or virus)

  • bacteria or virus

  • sound or pressure

  • body stressing

  • biological factors

  • mental stress

  • hitting objects with part of the body

  • being hit by moving objects

  • heat, radiation, or energy

  • chemicals or other substances]

(12)

Agency of notifiable injury or illness or notifiable incident (if fatality): [select 1 or more of the following:

  • machinery or (mainly) fixed plant

  • mobile plant or transport

  • powered equipment, tool, or appliance

  • non-powered handtool, appliance, or equipment

  • chemical or chemical product

  • material or substance

  • environmental exposure (for example, dust or gas)

  • animal, human, or biological agency (other than bacteria or virus)

  • bacteria or virus].

Compare: SR 2013/483 Schedule 7