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Health and Safety

HEALTH AND SAFETY
TABLE OF CONTENTS
1
Table of
contents
Introduction 4
Health and Safety in Employment Act 1992 5
Who is responsible? 5
Employer responsibilities 5
Employee responsibilities 6
Volunteers 6
Role of OSH 8
Accident Compensation Corporation (ACC) 9
Smoke-free Environments Act 1990 10
Workplace health and safety systems 11
Employer commitment and policy 11
Hazard identification and management 12
Prioritising hazards 12
Controlling hazards 14
Monitoring hazards 14
Stress in the workplace 14
Occupational Overuse Syndrome 15
Manual handling 15
Workplace health and safety systems summary 16
Accident management 17
Accident management summary 17
Emergency management planning 18
Fire 18
Other emergency procedures 19
First aid 19
Civil defence supplies 20
Emergency management summary 20
Staff training, supervision and participation 21
Information for employees 21
Training or supervision 21
Suitable protective clothing and equipment 21
Staff participation 22
Health and safety representatives 22

2
Contractors and visitors 24
Health and safety and events 25
Event risk management process 26
Appendix 29
Appendix 1: Example health and safety programme plan 31
Appendix 2: Sample hazard register 33
Appendix 3: Sample employee health and safety handbook 34
Appendix 4: Event management risk profile template 42
Appendix 5: Sample health and safety manual 43

It isn’t the mountains
ahead to climb
that wear you out; it’s the pebble
in your
shoe.
Muhammad Ali

4
Introduction
This toolkit is designed to assist managers to meet their obligations under the Health
and Safety in Employment Act 1992 (HSE Act), the Health and Safety in Employment
Amendment Act 2002 (Amendment Act) and associated legislation. It will also help
you to set up new, or review your existing, health and safety policy and procedures.
This resource is designed to be read in conjunction with other SPARC publications such
as the ‘People Management’ and ‘Risk Management’ toolkits.

HEALTH AND SAFETY
HEALTH AND SAFETY IN EMPLOYMENT ACT 1992
5
Health and Safety
in Employment Act 1992
The main Act for the management of health and safety is the Health and Safety in
Employment Act 1992 (HSE Act). The principal objective of the Act is to provide for the
prevention of harm to employees while at work and to other people in the vicinity of a
workplace. The HSE Act is supported by regulations, guidelines and codes of practice
which control specific health and safety issues. A place of work is defined very broadly
as any place (not necessarily part of a building or structure) where any person is to
work, is working for the time being, or customarily works for gain or reward.
The Act does not tell people how to make the workplace safe; rather, it requires that
they have taken all reasonable practicable steps to make work safe. It recognises that
those involved in the work (employers and employees) are in the ideal position to
decide on the best way to make their workplace safe.
The Health and Safety in Employment Amendment Act 2002 increased the principal
coverage of the HSE Act to include protection to volunteers (excludes sports
organisations), persons in on-the-job training/work experience and employees on loan.
The amendment also confirms that harm can occur from work-related stress and that
temporary conditions may cause a person’s behaviour to be hazardous.
The guidelines and appendices in this section will help you to understand your duties
and responsibilities, and those of your employees, in relation to health and safety.
Who is responsible?
There is a shared responsibility by employers, employees and others to ensure a safe
and healthy workplace. Under the HSE Amendment Act in 2002, employees are
required to take part in the process of maintaining a safe and healthy workplace.
Employer responsibilities
As an employer, under the Act, it is primarily your responsibility to ensure that work is
carried out in a safe and healthy manner by performing the following duties:
• Provide and maintain a safe working environment (refer HSE Act
sections 6, 7).
• Provide and maintain facilities for the health and safety of employees at
work (refer HSE Act section 6).
• Ensure any equipment in the place of work is designed, set up and
maintained to be safe for employees (refer HSE Act section 6).
• Ensure systems of work do not lead employees to be exposed to hazards in
or around their place of work (refer HSE Act sections 7-10).
• Develop procedures for dealing with emergencies that may arise while
employees are at work (refer HSE Act section 12).
• Train and supervise employees (refer HSE Act section 13).
• Involve employees in the development of health and safety procedures
(refer HSE Act section 14).

6
Employee responsibilities
Employees also have a responsibility under the HSE Act:
Not to endanger themselves or others (refer HSE Act section 19).
This includes:
• following the employer’s instructions regarding hazards in the place of
work, and health and safety practices
• reporting hazards
• using and caring for protective clothing and equipment and emergency
equipment
• not misusing or damaging equipment
• cooperating with the monitoring of workplace hazards and employees’
health (with permission)
• reporting work-related injuries or ill health
• not undertaking work that is unsafe. The Act provides that an employee
may refuse to do certain work if that employee believes the work is likely to
cause them serious harm
• not interfering with an accident scene (refer HSE Act section 26)
• complying with notices or other requirements of health and safety
inspectors and departmental medical practitioners from OSH (including
improvement or prohibition notices) (refer HSE Act sections 31, 33, 35, 37,
39-45).
An employee with supervisory or management responsibilities may also represent
the employer and therefore have employer responsibilities in addition to their own
responsibilities, for example ‘being in control of the place of work’.
Volunteers
The Act describes a volunteer as any person who does not expect to be rewarded for
work undertaken in their capacity as a volunteer and has not received any reward for
this work. A person who is in a place of work for the purpose of receiving on-the-job
training or gaining work experience is not included in the definition of volunteer by the
Act. This means your organisation should ensure a safe work environment for anyone
who is receiving on-the-job training or gaining work experience.
If a volunteer does work on a regular and ongoing basis and the work is regarded as an
integral part of the business or operation, those volunteers will be covered by certain
parts of the Act, in particular the obligation to provide a safe work environment.

HEALTH AND SAFETY
HEALTH AND SAFETY IN EMPLOYMENT ACT 1992
7
Certain volunteers are excluded by the Act, including those assisting with sport and
recreation for:
• a sports club
• a recreation club
• an educational institution.
Volunteers, such as those assisting with sport and recreation, who are not afforded
specific and enforceable coverage under section 3C of the Act are provided general
declaratory coverage under section 3D of the Act. This requires that all practicable
steps be taken to ensure health and safety of the volunteer while he or she is doing
work activity. If an OSH inspector is aware of a significant hazard that may affect
the volunteer, the Inspector will request that steps be taken to eliminate, isolate or
minimise the hazard as opposed to requiring steps to be taken. In summary, volunteers
who are involved in sporting activities are still covered by the Act but the obligations to
provide a safe environment under the Act are not enforceable.

8
Role of OSH
The Occupational Safety and Health service (OSH) of the Department of Labour
(DOL) administers and enforces the HSE Act. Health and safety inspectors provide
information to employers and ascertain compliance with the Act. They are able to issue
enforcement notices and prosecute under the HSE Act (refer HSE Act sections 29-45).
Enforcement notices consist of improvement, prohibition or infringement notices.
Improvement notices require the workplace to comply with various sections of the
Act in a given timeframe. For example, a hazard notice that informs you that there is
a hazard in the workplace must be dealt with. Before issuing this notice the Inspector
must have tried to discuss the hazard with you. There is no penalty or fine associated
with a hazard notice, but continued non-compliance may result in further action by a
health and safety inspector.
A prohibition notice is issued where it is determined that there is risk of serious
harm occurring and may specify that employees are withdrawn from the work area.
Continued non-compliance may result in an instant fine (infringement notice)
or prosecution.
Infringement notices may be issued for continued non-compliance with the Act and
may result in an infringement notice which requires you to pay an instant fine (ranging
from $100 to $4000).
If a notice is issued and not complied with, the employer may be prosecuted (refer HSE
Act sections 49, 50). If it is determined that you, as the employer, have not taken all
reasonable practicable steps to ensure a safe workplace your organisation can be liable
for a fine of up to $250,000. Refer to the OSH enforcement policy A Guide to the
Health and Safety in Employment Act 1992 (OSH, 2000).
If an employee has suffered serious harm as a result of your knowingly operating an
unsafe workplace (e.g. an accident occurs more than once in the same way), the fine
can be up to $500,000.

HEALTH AND SAFETY
ACCIDENT COMPENSATION CORPORATION (ACC)
9
Accident
Compensation
Corporation (ACC)
As an employer you are responsible for providing your employees with both a safe
workplace and ACC cover (through levies) for work-related injuries.
ACC WorkPlace Cover levy rates are determined by the cost of work-related injuries in
an industry sector. So the fewer injuries that occur overall, the less each employer will
have to pay in levies.
Employers are able to participate voluntarily in an ACC workplace safety management
practices programme or an ACC Partnership Programme.
The workplace safety management practices programme can be used to strengthen
your existing health and safety systems and offers the following benefits:
• It gives you an externally audited, national safety framework to work to.
• It proves your safety commitment to staff and members or associates.
• It rewards you with ACC levy discounts.
• It works to reduce injuries.
Discounts on your ACC WorkPlace Cover levy are awarded on three levels, to recognise
how comprehensive and effective your workplace safety management practices are.
The three levels are:
• Primary (10% discount)
• Secondary (15% discount)
• Tertiary (20% discount).
ACC will decide whether a discount is awarded, and at what level, on the basis of an
independent audit of your workplace safety systems and procedures. Discounts apply
for 24 months, starting from the first of the month after a successful audit.
If you are willing and able to manage your own accident cover and employee claims,
you can become part of the ACC Partnership Programme. Under the Programme,
you effectively agree to act on behalf of ACC for your work-related injuries. There are
two cover options to choose from – the Partnership Discount Plan, and the Full Self-
Cover Plan. Your organisation would need advanced health and safety systems and
infrastructure to support this programme.
More information is available through ACC: www.acc.co.nz

10
Smoke-free
Environments Act 1990
It is a requirement of the Smoke-free Environments Act 1990 that all employers have
a written policy on smoking for all areas occupied by the employer and frequented by
employees. This policy should be reviewed in consultation with employees every year.
You also need to ensure there are prominent notices indicating where smoking is not
permitted and locating permitted smoking areas (such as a sheltered outdoor balcony).
You will need to develop a policy that meets the requirements of the Smoke-free
Environments Act 1990 and the Smoke-free Amendment Act 2003. It should be based
on the following principles:
• Everyone is entitled to a smoke-free environment in all the areas normally
used for work.
• Everyone who does not smoke, or who does not wish to smoke in their
place of work must, as far as is reasonably practicable, be protected from
tobacco smoke in their place of work.
• The implementation a smoke-free policy depends on everyone responding
courteously to the desire for a smoke-free environment.
Recent amendments to the Act now place an obligation on the licensee of any licensed
premises to take all reasonable practical steps to ensure that no person smokes at
any time in any part of the premises other than an open area. This also applies to the
operator of a restaurant. If a sporting organisation runs a bar or restaurant then it must
ensure it takes reasonable steps to prohibit members and patrons from smoking in the
restaurant and/or bar.
The Act also imposes controls on the marketing, advertising and promotion of tobacco
products and their association through sponsorship of other products and events. A
sporting organisation should not be involved in any sponsorship or advertising that
involves tobacco products.
More information is available through the Ministry of Health: www.moh.govt.nz

HEALTH AND SAFETY
WORKPLACE HEALTH AND SAFETY SYSTEMS
11
Workplace health
and safety systems
The main components of the Act require employers to show commitment to health
and safety by providing systems and resources for:
• employer commitment and policy
• hazard identification and management
• accident management
• emergency management
• employee information, training and supervision
• employee involvement
• working with contractors.
Employer commitment and policy
When developing a Health and Safety policy manual (refer example appendix 5), you
should list the objectives of the health and safety programme and how these objectives
will be achieved. Objectives should be SMART – specific, measurable, achievable, realistic
and time-bound (including a target date for completion). You should also document
who is responsible for achieving the objectives and ensure these objectives are reviewed
annually. An example plan from the ACC website is provided in appendix 1.
Your organisation’s commitment to a health and safety programme should include a
statement and an outline of staff and management accountabilities. A copy of your
health and safety policies should be documented in the health and safety manual and
there should be an abridged version in the health and safety employee handbook to
ensure that your organisational commitment is fully recognised.
Policies and procedures should be approved and regularly reviewed (for example yearly
or two-yearly) to ensure that they are up to date (legislatively and organisationally).
They should be authorised, signed and dated. A list of policies commonly found in a
health and safety manual is provided in appendix 5 – Manual review checklist.

12
Hazard identification and management
Hazard Identification
Section 7 of the HSE Act requires employers to have in place effective methods to
systematically identify hazards to employees at work. Hazards may be:
• previously existing
• new
• potential.
Hazards can be identified by:
• physical inspection of the workplace, equipment and work practices
• analysis of ‘near miss accidents’ to determine the cause and prevent
accidents of this nature in future
• analysis of tasks and how they are carried out in the workplace.
Once identified, hazards must be assessed and significant hazards controlled.
A significant hazard is a hazard that is an actual or potential cause or source of:
• serious harm
• harm where severity of harm relates to the frequency or extent of exposure
• harm which does not usually occur and is not easily detectable until a
significant time after exposure to the hazard.
Hazard identification and controls must be completed for each new or modified piece
of equipment. An example of a hazard identification process is outlined in appendix 5
– Hazard management policy.
Prioritising hazards
It is possible that in the process of identifying hazards there may be a number of
significant hazards. Undertaking a risk assessment for each hazard will assist in
prioritising hazard control methods. There are several methods available to determine
risk. This involves considering two factors:
• Likelihood (the probable frequency that an injury or illness will occur as a
result of the hazard).
• Impact (the severity or degree of injury or illness that could occur as a result
of the hazard).
The risk assessment method below is consistent with the SPARC Organisational Risk
Management Toolkit. Refer to the SPARC website: www. sparc.org.nz. Likelihood and
Impact are rated separately on a scale of 1 to 5 and then a risk level is determined as to
whether the risk is a critical, high, moderate or low level risk. Likelihood, impact scale
and risk assessment charts are provided below.

HEALTH AND SAFETY
WORKPLACE HEALTH AND SAFETY SYSTEMS
13
Likelihood scale
Score Scale Frequency of accident or illness
1 Rare May occur only in exceptional circumstances, e.g. less than 5%
chance of occurring
2 Unlikely Could occur at some time, e.g. 5-29% chance of occurring
3 Possible Should occur at some time, e.g. 30-59% chance of occurring
4 Likely Will probably occur in most circumstances, e.g. 60-79% chance
of occurring
5 Almost
certain
Will occur in most circumstances, e.g. 80%+ chance of occurring
Impact scale
Score Scale Severity of accident or illness
1 Minimal Negligible injury or illness
2 Minor Minor injury or illness requiring minor first aid and/or less than
one week’s recovery
3 Moderate Injury or illness requiring advanced first aid and medical visit
(e.g. GP or hospital visit) and/or 1-6 weeks’ recovery
4 Major Injury or illness requiring advanced first aid and emergency
medical assistance (e.g. hospitalisation) and/or more than
6 weeks’ recovery
5 Extreme Injury or illness requiring immediate emergency medical assistance
and may result in permanent or long-term disabling effects or
death. Hospitalisation likely to be for more than 6 weeks
Risk assessment chart
Likelihood
Almost
certain
Impact
Minimal Minor Moderate Major Extreme
H H C C C
Likely M H H C C
Possible L M H C C
Unlikely L L M H C
Rare L L M H H
Legend:
C
H
M
L
Critical risk; immediate action required
High risk; senior management attention is needed
Moderate risk; management responsibility must be specified
Low risk; manage by routine procedures
When the risk has been determined, this should be entered into the hazard register
(see example in appendix 2). The higher the risk, the greater the priority to control
the hazard.

14
Controlling hazards
Sections 8-10 of the HSE Act require that once hazards are identified you must
eliminate, isolate or minimise them as follows:
• To eliminate a hazard you would change the situation so that the hazard
no longer exists (e.g. fix an uneven floor).
• If this is not possible, you should attempt to isolate the hazard by putting in
place a process or mechanism that keeps employees away from the hazard
(e.g. wash floor outside work hours to prevent a slipping hazard).
• If this is not possible, then you must minimise the hazard by doing all
you can to protect employees from harm (e.g. put signage up to warn of
tripping/falling hazards on stairs).
Appointed health and safety representatives are required to have training for the
identification and control of hazards and are responsible for maintaining a hazard
register. Specialist advice may be sought to control specific hazards (such as
dangerous substances).
A hazard register (see example in appendix 2) lets employees know of the potential
areas of harm in the workplace. This list must be kept up to date and made available
to existing employees. It should also be included in new employees’ induction packs.
However, it is everyone’s responsibility to identify hazards, complete a hazard
notification form (see example in appendix 5 – Hazard notification form) and discuss
the issue with the nominated health and safety manager.
Monitoring hazards
Where a hazard cannot be eliminated and a minimisation approach is taken to manage
a significant hazard, employers are required to monitor employees’ health (with the
employees’ consent) in relation to exposure to the hazard.
Monitoring ensures that the control measures implemented remain appropriate
and can be changed if the hazard characteristics have changed. The frequency of
monitoring should be determined based on the risk and potential for change in the
characteristic of the hazard. We tend to think of hazards as things that cause physical
harm, but amendments to the HSE Act in 2002 emphasised that stress and fatigue
have potential to cause harm also. You should, therefore, monitor your employees’
health in terms of both physical and mental wellbeing.
Monitoring may be by way of survey, visual inspection or sophisticated analysis
(for example audiometry).
Stress in the workplace
Everyone experiences stress from time to time and most of us have ways in which we
deal with it. Prolonged exposure to high levels of stress, however, may be detrimental
to a person’s health. Whilst it is difficult to monitor each employee’s level of stress, you
are required to ensure that your work practices don’t cause unnecessary harm. In the
same way you are required to put systems in place to manage other hazards, you must
have systems to deal with stress in the workplace.

HEALTH AND SAFETY
WORKPLACE HEALTH AND SAFETY SYSTEMS
15
For example, stress can be:
• inherent in the job
• a result of the way the job is organised (e.g. shift work, unpredictable work
peaks)
• a result of excessive work demands
• related to personal factors (e.g. relationship status, financial issues etc).
If you become aware of the fact that an employee is suffering from stress, you must
have systems in place to assist to reduce the potential for harm. The best place to start
is an open discussion with the employee. If their source of stress is work related (e.g.
high workload, job content, conflict with colleagues) you can work together to take all
reasonable practicable steps to reduce the stressful situation.
Whilst you have no control over an employee’s personal life and external factors that
may impact on a person’s ability to cope at work, you are still required to take some
simple and practicable steps to help an employee deal with personal issues (if you
know about them). Some examples of the kind of support you could provide in this
situation are flexible work arrangements, reduced workload, paid leave or support to
attend counselling.
You will need to decide on the best ways to monitor stress levels and appropriate
systems to manage stress in your workplace.
Occupational Overuse Syndrome
Occupational Overuse Syndrome (OOS) is a collective term for a range of conditions
(including injury) characterised by discomfort or persistent pain in muscles, tendons and
other soft tissues. Every case of OOS has the potential to be classified as a significant
hazard because the condition may cause ‘serious harm’. Therefore the risk factors
for OOS need to be controlled by eliminating the hazard if at all possible, or else by
isolating or minimising the hazard.
There is an approved code of practice for OOS available through OSH:
www.osh.dol.govt.nz
Manual handling
‘Manual handling’ is defined as any activity requiring a person to lift, lower, push, pull,
carry, throw, move, restrain, hold or otherwise handle any animate or inanimate object.
Any manual handling tasks that are likely to be a risk to health and safety in the
workplace require hazard assessment and management. Staff should be provided with
appropriate training where manual handling tasks occur in the workplace. There is a
Code of Practice for Manual Handling published jointly by OSH and ACC. The code can
be downloaded from either the OSH or ACC websites.

16
Workplace health and safety systems summary
Keep your workplace SAFE by following this simple mnemonic:
S Stop Look at the work, activities, equipment and substances
A Assess Does the work present any hazards that can cause harm?
Are they significant hazards?
Are controls sufficient?
F Fix Correct any hazards
Eliminate, isolate or minimise
E Evaluate Continue to monitor the hazard and controls
Are controls effective?

HEALTH AND SAFETY
ACCIDENT MANAGEMENT
17
Accident
management
The Act requires you to keep a record of all accidents (including near misses) at work.
You should record this information in an accident register, an example of which is
included in appendix 5 – Accident form/register. The accident register also includes an
accident investigation portion to find out what happened, what the causes were and
what can be done to prevent it occurring in future.
Serious harm must be reported to OSH as soon as possible after the event and in
writing within seven days of the harm occurring. Serious harm is described in the first
schedule of the HSE Act.
Employees need to know how to manage an accident or incident. This information
should be contained in the health and safety policy manual and should include:
• what to do if you are involved in a work accident or incident
• how to react in an emergency when you are ‘on the scene’
• the reporting and investigation process.
Accident management summary
After the initial management of the accident or incident (first aid), the process for
managing the accident should include:
C Correct Return to SAFE to correct the hazard
A Accident Report the accident/incident as required
Report serious harm. Contact the health and safety manager
immediately
R Rehabilitate Get involved in the rehabilitation process
Provide a supportive environment for rehabilitation
E Evaluate Has the rehabilitative process been successful?
Will the steps in place prevent similar events?
What have we learnt from the process?

18
Emergency
management planning
Fire
The Building Act 1991 requires evacuation schemes for public safety where any
building is used as a place:
(a)
(b)
where 100 or more people are able to be present for different purposes or
activities; or
where facilities for employment are provided for more than 10 people
(whether self-employed or employed by one or more employers).
An evacuation procedure is required where facilities for employment are provided for
fewer than 10 people. The evacuation procedure is put in place by the owner of any
building to ensure the safety of all occupants when evacuating in the event of a fire.
It must detail:
• what to do if a fire is discovered
• what to do if the fire alarms sound or you are warned of a fire
• how to get out of the building in an emergency
• what the fire alarm signal is.
An evacuation scheme is an enhanced evacuation procedure that must be approved
by the Fire Service. If an evacuation scheme is required, it is the responsibility of the
building owner to ensure there is an approved and maintained evacuation scheme.
An evacuation scheme will describe procedures for:
• what to do if you discover or are warned of a fire
• the duties and roles of wardens appointed to supervise the evacuation
• how to evacuate the building promptly to a place of safety
• how all building occupants are accounted for during an evacuation
• how to ensure that all persons with disabilities, including staff, visitors and
associates are assisted and accounted for during an evacuation
• fire action notices in the building
• the maintenance of the evacuation scheme
• the safe operation of fire fighting equipment in the building.
Section 21A(9) of the Fire Service Act 1975 allows for a waiver from the requirement
to provide an evacuation scheme for a building. A waiver can only be granted when
the Fire Service is satisfied that:
• the building has an adequate warning system
• occupants can evacuate unsupervised or unassisted
• disabled occupants do not require specialised care
• any evacuation would be safe, expeditious and efficient
• the building complies with the building code
• all exits are obvious to visitors.

HEALTH AND SAFETY
EMERGENCY MANAGEMENT PLANNING
19
Your organisation should have access to either an evacuation scheme or evacuation
procedure. It is important that all staff familiarise themselves with this. There should be
a nominated building warden and floor warden if you are located on more than one
floor of a building. Fire warden training should be provided to a delegated fire warden.
Links to training providers can be found on the New Zealand Fire Service website.
A fire drill (or trial evacuation) must be conducted every six months. If a false alarm
is raised, this can be considered a drill. Following a fire drill, the process should
be evaluated to identify any areas of concern or improvement. A checklist can be
downloaded from the New Zealand Fire Service website.
Further information on fire evacuation schemes, procedures and forms can be found
at www.fire.org.nz
Other emergency procedures
Employees should know and understand what to do in the event of an emergency.
Other emergency procedures that require a written policy or process include
earthquake, flood, bomb scare, armed hold-up, aggressive or violent situations, and
security (working alone) (refer example health and safety manual in appendix 5).
Further information is available at: www.civildefence.govt.nz/memwebsite.nsf/
wpg_URL/Being-Prepared-Businesses-Index
First aid
The Act requires you to take all practicable steps in providing effective first aid
arrangements. This means that you should have a nominated person on your staff
who has had first aid training. A certified workplace first aider is an individual that has
completed the two-day (16-hour) workplace first aid qualification. This qualification
requires a two-yearly refresher course of one day. There are many first aid providers.
A current list is available at: www.mcdem.govt.nz/memwebsite.NSF/wpg_URL/
Being-Prepared-What-to-do-First-Aid?
Additionally, you need to provide basic first aid supplies in every place of work while
work is in progress. Where timely and convenient access to appropriate medical or
ambulance services is restricted due to distance or remote location, then at least
two trained personnel should be provided for up to every 10 employees. Employers
also need to take into account their duties to people other than employees such as
members of the public or participants at sports events that you may be responsible for.
OSH provides guidance notes on providing first aid equipment, facilities and training,
accessed from their website. Please see appendix 5 – First aid policy, for a list of
recommended minimum first aid kit contents for the workplace, and appendix 5 –
First aid register, for a sample first aid register.

20
Civil defence supplies
As part of your emergency management planning, you should ensure there are
adequate civil defence supplies held at your place of work, as this is a practical step
the employer can take to ensure staff safety in such an emergency. The general rule of
thumb is to have enough supplies such as food, water and blankets for your staff for
three days. More information is available through your local city council; a link to your
local city council is available at www.civildefence.govt.nz
Emergency management summary
Four components (4 Rs) are common to the approach taken in emergency
management:
R Reduction Reduce the risk of emergency events occurring and their potential
impact (hazard management process)
R Readiness Plan the response to an emergency event (policies and procedures are
developed and known to all staff)
R Response What to do when an emergency event occurs (staff implement
emergency management policies and procedures)
R Recovery Review emergency response after the event – debrief staff and
recommend changes to the emergency management policies and
procedures if required

HEALTH AND SAFETY
STAFF TRAINING, SUPERVISION AND PARTICIPATION
21
Staff training,
supervision and participation
Information for employees
You must provide your employees with information about:
• hazards in the workplace
• hazards that may arise from work they are doing
• the steps taken to minimise the likelihood of harm occurring from these
hazards
• where to find, how to use and how to maintain safety clothing and
equipment
• how to deal with any emergencies that arise
• injury and accident reporting
• employee and employer responsibilities.
Appendix 3 contains an example of an employee health and safety handbook as a
guideline. It gives a general overview of the type of information you could cover; you
will need to tailor this information to the specific procedures and processes you follow
for health and safety. You will need to decide what information to include in your
employee health and safety handbook, and the way in which the information should
be delivered to meet the needs of your workplace and employees. Make sure you use
appropriate language for your employees, so that the information is easy for everyone
to understand. You should also ensure that your organisation’s health and safety
manual is readily available to staff.
Training or supervision
You are legally required to do everything possible to ensure that employees have
adequate knowledge, experience, supervision and training to do their work safely.
An induction process for new employees should include health and safety matters
including identification and management of hazards.
Appendix 3 – Induction of new employees contains a checklist for health and safety
induction of new employees.
Suitable protective clothing and equipment
If the role requires it you must provide suitable clothing, equipment and instructions
on how to use it properly. It is not acceptable to give your employees money in lieu
of clothing or equipment, or require them to provide their own (unless the employee
volunteers to use his or her own equipment and you are satisfied it is suitable). It is
your responsibility to ensure that all safety equipment, including protective clothing,
is maintained. An example within sport and recreation would be the provision of
reflective vests for staff whilst involved in an event (e.g. road or cross-country) where it
is important that staff are highly visible to reduce risk of injury to either a staff member
or competitor in an event.

22
Staff participation
You must provide opportunities for employees to contribute to health and safety within
the workplace. According to the Act, employees who wish to be involved (and union
representatives if appropriate) are required to work together to develop, implement
and maintain an employee participation system. This is simply a system that gives
employees a reasonable opportunity to have input into health and safety. You should
be able to demonstrate employee participation through documentation of meetings
and activities that should occur at least quarterly.
You are required to develop an employee participation system if:
• your organisation has more than 30 employees;
• you employ fewer than 30 employees and one of the employees or a union
representing them asks for an employee participation system.
If you already involve your employees in your health and safety processes, and all
parties agree to maintain the status quo, you don’t need to set up a new employee
participation system. You will, however, need to set up a process by which your
system can be reviewed, such as a staff survey that ascertains satisfaction with current
employee participation.
Your employee participation system should reflect the needs of your organisation.
Examples of the things you might like to include are:
• the election of employees to act as health and safety representatives, either
acting as individuals or as part of a health and safety committee (please see
below for more information on health and safety representatives)
• the employees’ role in hazard identification
• setting up a process for ensuring regular cooperation between you and
your employees on health and safety matters
• deciding on how many days’ paid leave will be allocated to each
representative for health and safety training.
Health and safety representatives
Your elected representatives can work either individually to promote health and
safety in the workplace or as part of a health and safety committee. Either way their
objectives will be the same and may include things such as:
• encouraging a safe and healthy work environment for all employees
• raising awareness of health and safety in the workplace
• identifying potential hazards in the workplace
• discussing ways to manage the hazards with the employer
• investigating health and welfare complaints by employees
• investigating and recording accidents
• keeping up to date with health and safety policy and legislation.
To be effective in their role your health and safety representatives must understand
health and safety matters. To facilitate this, they are allowed, under the Act, to take
paid leave to attend approved courses. A list of these courses is available from the
Employment Relations Service website: www.ers.dol.govt.nz

HEALTH AND SAFETY
STAFF TRAINING, SUPERVISION AND PARTICIPATION
23
The Act provides a formula for how many days’ paid leave for approved training you
are required to provide for your health and safety representatives and is based on the
number of employees you have in your organisation as follows:
Number of employees
Maximum total number of days’ paid leave the employer
must provide
1 – 5 2
6 – 50 6
51 – 280 1 day for every 8 employees, or part of that number
281 or more 35 days plus 5 days for every 100 employees, or part of that number

24
Contractors
and visitors
Contractors and visitors are covered by the Act when they come into your workplace
and it is your responsibility to advise them of health and safety procedures and their
responsibilities in relation to these. The key things you may wish to advise on are:
• building evacuation procedures
• the need to take all practicable steps to ensure their own safety and that of
others (this includes advising a staff member of any special assistance that
may be required in case of an emergency requiring evacuation)
• reporting all accidents and near misses
• complying with health and safety policy and procedures.
Visitors and contractors can be protected against hazards by use of a combination
of signage, restricted access, supervision and security.
You should ensure that there is a record kept of all contractors and visitors on-site.
If contractors or visitors are not escorted, then you may wish to issue them with an
identity badge and have them sign an acknowledgement that they have read and
understood the health and safety visitor requirements while on the premises.
You must ensure that contractors provide you with details of any hazards that they may
bring on-site or of any hazards they may create as a result of the nature of work being
undertaken together with how these hazards may be mitigated.

HEALTH AND SAFETY
HEALTH AND SAFETY AND EVENTS
25
Health and safety
and events
Most sporting organisations are involved in event management, which requires careful
consideration of health and safety issues. If you are an event organiser, you have a duty
of care to ensure that staff, participants, spectators, volunteers and the general public
are protected from avoidable risk. It is also your responsibility to undertake a hazard
and risk assessment.
The types of hazards that you might encounter relating to health and safety
may include:
• accident and first aid matters (participant competitors, officials,
staff, spectators, volunteers)
• structural collapse
• human waste disposal
• crowd control
• lost children
• traffic
• loss of utilities (water, sewerage, etc)
• hazardous materials
• food waste disposal
• an emergency such as fire, earthquake, evacuation
• security
• communication issues
• food handling.
It is important to consider every possible hazard and risk that may occur and
manage these risks. This may require some expert advice including formation of a
committee where specific responsibilities are assigned to ensure that health and safety
responsibilities are comprehensively managed. After identifying risks and assessing
these, you need to implement a risk mitigation strategy so that risks can be either
eliminated or mitigated. If a risk occurs, you will then be prepared to deal with it
appropriately and meet your legal obligations to do so. The event risk management
process is summarised in figure 1. An example checklist from the SPARC Organisational
Risk Management Toolkit is in appendix 4.

26
Event risk management process
1. Identify event
2. Identify risks and their causes
3. Identify controls
4. Conduct risk analysis
Consider
likelihood
Examine
impact
Determine risk level
5. Evaluate risks
Is the risk acceptable?
Yes
No
Implement controls
in step 3
What more should
be done? Go back
to step 3.
6. Write plan
7. Implement and
communicate plan
8. Monitor/Review
FIGURE 1: RISK MANAGEMENT OVERVIEW (ADAPTED FROM AS/NZS 4360)

HEALTH AND SAFETY
HEALTH AND SAFETY AND EVENTS
27
Event management should include liaison with local government, emergency services,
Transit New Zealand (if applicable) and insurers who can support event organisers,
including providing advice on planning, required permits and licences.
More information related to health and safety and events includes:
• SPARC Organisational Risk Management Toolkit: www.sparc.org.nz
• The New Zealand Standard SNZ: HB 8669:2004 Guidelines for Risk
Management in Sport and Recreation. Available through Standards New
Zealand: www.standards.co.nz
• Safety Planning Guidelines for Events, available through
www.osh.dol.govt.nz
• Safety Planning Guidelines for Events forms, available through
www.osh.dol.govt.nz

Appendix

HEALTH AND SAFETY
APPENDIX 1
31
Appendix 1
Example health and safety programme plan
{Insert your company name here}
Overall objective
To achieve the Primary level of the ACC Workplace Safety Management Practices
programme by {insert date here}.
Objective Action Plan Person Date Status 1 Budget
1. Adopt and
implement
the
organisation’s
health and
safety manual
by {insert date
here}
2. Establish the
health and
safety team
by {insert date
here}
3. Review the
hazards in the
workplace by
{insert date
here}
4. Complete
a review
of training
practices by
{insert date
here}
i. Review the policy, make the
necessary changes, and sign and
date it
ii. Distribute and publicise the policy
iii. Establish the incident and
injury register and meet with all
employees to advise them of the
process for reporting incidents
and injuries
i. With employee representatives,
agree upon the process for
selection of the health and
safety team
ii. Develop the timetable for the
meetings (at least quarterly)
iii. Confirm the actions that the team
will undertake for the coming year
i. Review the organisation’s generic
hazard register
ii. Identify site-specific hazards,
assess to see if they are significant
hazards and develop appropriate
controls
iii. Train staff in the methodology
iv. Undertake the necessary
workplace monitoring and
personal health monitoring
i. Identify training needs for each job
position
ii. Establish competence level of all
staff
iii. Identify suitable training courses/
trainers/training programmes
1
Status refers to whether the objective is active or completed and may also record final cost if completed.

32
Annual and ongoing activities
Element Action When Responsibility Status
Employer
commitment
Planning, review
and evaluation
Hazard
identification,
assessment and
management
Incident and
injury reporting,
recording and
investigation
Employee
participation
Emergency
planning
i. Review the policy Annual Health and safety
representatives
i. Review the current health
and safety plan
ii. Prepare the health and safety
plan for the coming year
iii. Complete annual selfassessment
i. Update hazard identification,
including hazards associated
with new or changed
equipment
and processes
ii. Review the hazard register
to ensure that controls are in
place and effective
iii. Complete monthly workplace
inspections
iv. Undertake workplace and
personal health monitoring
i. Review and analyse the
incident and injury data
i. Health and safety
representatives to meet
regularly
i. Arrange two emergency
evacuation exercises
ii. Re-examine/update the
emergency plan after each
exercise
Annual
Annual
Annual
Annual
Monthly
Annual
Annual
Quarterly
Health and safety
representatives
Health and safety
representatives
Health and safety
representatives
Health and safety
representatives
6 monthly Health and safety
representatives
Source: adapted from an example found at: www.acc.co.nz

HEALTH AND SAFETY
APPENDIX 2
33
Appendix 2
Sample hazard register
Hazard Identification and Analysis Action
Significant
Hazard and potential
harm
hazard?
Practicable to Controls required
Eliminate? Isolate? Minimise? (including existing)
Person
responsible
Date of
action
Completed
by
Yes/No
Yes/No
Yes/No
Yes/No
Risk
category
Lifting/manual
handling – risk of back
injury
M Y Y Make arrangement with couriers to
handle heavy packages or take them
where they need to go
Use trolley
Ask for assistance
Training in back care
Refer OSH publication Code of Practice for
Manual Handling
H&S rep …/… H&S rep
…/….
Computer use (VDU)
– risk of Occupational
Overuse Syndrome
(OOS)
M Y Y Make sure workstations are set up
Vary tasks as much as possible
Provide OOS training
Comply with the OSH publication
Approved Code of Practice for the use of
VDUs in the Workplace
…/… H&S rep
…/….
Workload – Stress L Y Y Ensure office is adequately staffed
Ensure staff are sufficiently trained to
complete work required
Make sure job descriptions are clear
Ensure staff use annual leave
entitlements
CEO …/… Annual
Review by
CEO
…/….
Loose flooring H Y Y Fix any areas of uneven flooring (temporary
signs to warn staff) and contract flooring
specialist to repair immediately
Office
Manager
…/… Contractor
.../…

34
Appendix 3
Sample employee health and safety handbook
{Insert your organisation name and logo here}
Employee health and safety handbook
1.0 HEALTH AND SAFETY
It is up to all of us to create a safe and healthy workplace. We need to work together
and do all we can to prevent accidents and illness in our work environment. This
handbook provides a summary of information relevant to health and safety in the
workplace and we ask that you familiarise yourself with it. We recognise that if we
work together on all aspects of health and safety we will get a better end result. Please
refer to the full policy and procedure manual for more detail.
1.1 As your employer it is our responsibility to:
• identify, manage and control hazards to establish safe work practices
• provide information to foster awareness of health and safety
• provide protective clothing and equipment as required
• make adequate preparations for emergencies
• record all accidents and ‘near misses’ and investigate where necessary to
ensure future accidents are avoided
• ensure you are properly trained and supervised to do your work in a
healthy and safe manner
• provide reasonable opportunities for you to be involved in health and
safety.
1.2 As an employee it is your responsibility to:
• contribute to the process of hazard identification, analysis and control
• ensure all work accidents and illnesses are reported and recorded
• use any protective clothing and equipment provided
• not undertake any work which is unsafe
• look out for the safety of fellow employees
• observe all workplace safety rules and hazard controls.
1.3 Induction
On joining the company you will be given information on our health and safety
procedures, health and safety representatives, access to first aid and evacuation
procedures. You will also be given a list of all hazards identified in our workplace
(hazard register) and the location of all safety equipment.
1.4 Hazard identification
We are all responsible for identifying potential hazards in the workplace. A list of
identified hazards should be included in your induction pack. Please let your health and
safety representative know if you see anything you consider hazardous so he/she can
add this to the hazard register and take action to prevent this from causing harm.

HEALTH AND SAFETY
APPENDIX 3
35
1.5 Getting involved in health and safety – employee participation
We are keen to encourage employees to share in the management of health and
safety in the workplace. If you wish to be involved please let our Health and Safety
Representative know.
1.6 First aid
We have first aid people who are trained to assist with emergencies. Please ensure
they are aware of any medical conditions you have which may need special treatment
should an emergency arise.
1.7 Smoking
All areas within the building are designated non-smoking. Smoking is permitted in
[area] outside.
2.0 HEALTH AND SAFETY PROCEDURES
2.1 Dealing with accidents
We are required to report all accidents, as part of our process of identifying and
dealing with hazards. All accidents must be recorded in the accident register, which
includes a record of every accident or incident (including ‘near misses’) at work.
When an incident occurs in the workplace please follow these steps:
• Make sure the injured person has received the required medical attention
(i.e. first aid, doctor or ambulance, depending on the severity of the
accident).
• Tell the Health and Safety Representative, who will carry out an
investigation and record the incident in the accident register.
When an accident involving serious harm occurs:
• don’t move the injured person
• seek appropriate medical assistance
• advise the Health and Safety Representative
• occupational Safety and Health (OSH) may wish to inspect the scene,
so don’t interfere with the accident scene unless:
– the person’s life is in danger
– it is essential to maintain access for the public to essential services
– it is necessary to prevent damage to, or loss of, property
• advise the local OSH branch as soon as possible by phone, fax or email
• cooperate with any investigation conducted
• send written confirmation (accident register) to OSH within seven days
• take steps to eliminate, isolate or minimise any identified hazard as soon
as possible.

36
2.2 Building evacuation procedure
As part of our health and safety programme, employees are required to be fully
conversant with the procedure to follow in the event of a fire or earthquake. Please
familiarise yourself with these procedures. Some key reminders are outlined below:
Fire safety
How to be fire safe:
• Don’t block fire exits
• Keep fire doors closed
• Take care with flammable materials
• Know the fire drill procedure (and who your fire wardens are)
• Know where fire extinguishers are located and how to use them.
In the event of a fire:
• if possible, operate the nearest fire alarm
• call 111
• use a fire extinguisher IF IT IS SAFE
• evacuate the building following the procedures below.
If you hear the fire alarm:
• immediately vacate the building via the closest fire exit (don’t use the lifts)
– refer to your organisation’s evacuation procedures here as appropriate
• make sure any visitors leave the building with you
• walk, don’t run
• don’t return for personal belongings
• keep to the left of the stairs
• report to the designated meeting point and don’t return until the all clear
is given.
Earthquake safety
To be earthquake safe, eliminate hazards such as:
• unsecured bookcases, shelves, cabinets, audiovisual equipment
• blocked doorways and passageways.
In the event of an earthquake:
• move away from windows and anything that could be dangerous if it falls
(e.g. partitions, bookshelves)
• find cover under tables, desks, doorways
• be prepared for aftershocks.
After the earthquake:
• evacuate if instructed to do so (it could be safer inside than out) using the
following procedure – refer to your organisation’s own evacuation
procedures here
• check for injuries – first aiders to assist with treatment
• check for hazards – beware of broken glass, live wires, and damage to
floors, walls and ceilings
• extinguish any fires.

HEALTH AND SAFETY
APPENDIX 3
37
3.0 WORKPLACE INJURY PREVENTION
Our aim is to prevent injury from occurring and provide the support required for you to
work safely in your workplace. Below are some common workplace hazards and ways
to help you avoid harm occurring from these hazards.
3.1 Visual display unit (VDU)
One of the most significant hazards in our environment is the VDU – this includes the
computer screen, keyboard and mouse. We will make all reasonable endeavours to
ensure you have a fully functional workstation that meets your needs. Where required,
a workstation assessment (example workplace assessment questions attached at the
back of this handbook) can be conducted to ensure your desk, chair, computer and
other office equipment are set up to minimise any potential risks.
Please see the diagram at the back of this handbook for the correct ergonomic set-up
for your workstation. Your health and safety representative will help you to set your
workstation up correctly to ensure you continue to work safely at your computer.
And remember you don’t necessarily need ergonomic equipment to set your
workstation up correctly. For example, a telephone book is one way to lift your screen
up to the correct eye level!
3.2 Occupational Overuse Syndrome (OOS)
OOS refers to a range of conditions characterised by pain or discomfort in the muscles,
tendons, and other soft tissues. Symptoms can include:
• Burning sensation
• Stiffness, aches and pains
• Soreness and weakness
• Numbness and tingling
• Muscle discomfort.
To minimise these symptoms always make sure you pause briefly (micro pause) when
completing repetitive tasks. For example, when working on a computer, pause every
3-5 minutes for 5-10 seconds, shake your wrists and stretch your fingers. Ensure you
maintain a good posture when working at your computer. Stand up and stretch as
often as you can. Ensure your mouse is located next to your keyboard so there is no
need to overreach. Use a mouse pad with a wrist support and an ergonomic keyboard.
If symptoms persist contact your health and safety representative.

38
3.3 Eye strain
Symptoms can include:
• Blurred vision
• Headaches
• Gritty tired eyes
• Sore and red eyes
• Dry or watery eyes.
To minimise these symptoms make sure you pause every few minutes and look away
from the screen. Minimise glare from light sources (e.g. tilt screen to avoid overhead
glare). Wherever possible, work in natural light. Use a copy holder if frequently copy
typing work on a PC. Make sure your screen viewing distance is 450 to 700mm.
If symptoms persist contact your health and safety representative.
3.4 Back pain
• Use equipment (e.g. trolley) to move heavy objects.
• Don’t use your back like a crane.
• Know your own strength – ask someone to help.
If you suffer from back problems at work, contact your health and safety
representative.
3.5 Workplace stress
You are the best judge of whether stress is having a detrimental effect on your health.
If you feel unable to cope as a result of workload, or other stressors in your role or your
personal life, please talk to someone you trust, e.g. your manager, your health and
safety representative, a counsellor, a colleague. Stress has the potential to cause harm
and we will do all we can to eliminate, isolate or minimise sources of stress to help you
perform your role in a safe and healthy environment.

HEALTH AND SAFETY
APPENDIX 3
39
You and your workstation
Posture
• Shoulders – keep low and relaxed.
• Upper arms – should be straight up
and down.
• Elbows – keep tucked close to the
body and bent 90–110° so that
forearms are horizontal or gently
sloping upwards.
• Wrists – need to be comfortably
straight. Can be bent up slightly.
Avoid bending wrists sideways.
Chair – general
• Ensure chair swivels easily and is
stable when force is applied to front,
sides or back.
• It should move freely on castors.
Chair – seat
• Should be comfortable but
firm enough to allow ease of posture
changes.
• Allow space between the front of the
seat and the back of the calf.
Chair – armrests
• Can limit posture changes and make
it difficult to reach work.
• If used ensure they have no sharp
edges and support the elbows and
forearms well.
• They must allow the chair to be
drawn up to the desk and have room
to move freely in the seat.
Chair – seat height
• Feet should be flat on the floor or on
a footrest to avoid pressure under the
thighs. Avoid sloping the thighs too
much.
• You should be able to make
adjustment whilst seated.
450-700mm
Desk
• There should be no movement or
vibration during normal use.
• The height range should be 600-
845mm (usually 720-730mm).
• Desk top needs to be thin to allow
comfortable legroom.
• Ensure there is space to rest wrists
on, between the edge of the desk
and the front of the keyboard
(100mm).
Screen
• Height, swivel and vertical tilt should
adjust.
• Viewing distance of 450-700mm
(general measure of one arm’s length
away from body).
• Angle of view 10–30° below
horizontal to the middle of the
screen.
Copy holder
• Use to avoid leaning forward while
reading.
• Position – place either beside the
screen or between the keyboard and
the screen.
• Position centrally or change from side
to side regularly.
Keyboard & mouse
• Stable and separate from screen.
• Mouse should be at the same level as
the keyboard.
Footrest
• Large enough to allow feet sufficient
room to move (400mm x 400mm
suggested).
• Nonslip top, angled slightly (0–10°).
• Stable and positioned close
to user.
• Adjustable to the specific height
required.
FIGURE 1: CORRECT ERGONOMIC POSITIONING

40
Important health and safety contacts and information
WHAT
Trained first aider
First aid kit
Hazard register
Accident register
Local doctor
Fire extinguishers
Fire exits
Fire wardens
Assembly points in event of evacuation
Health and safety representatives
WHERE/WHO (insert relevant location or
person’s name here)
I have read the above document and agree to abide by all required health and
safety procedures.
Name:
Signed:
Date:

HEALTH AND SAFETY
APPENDIX 3
41
New employee induction checklist
This is to be provided to a new employee on their first day of work.
Health and Safety Training Checklist
Health and Safety Manual information including:
• Emergency procedures
• Incident/accident reporting process
• Hazard identification
• Employer and employee responsibilities
• Work injury claims process
• Rehabilitation responsibilities
Provide information including:
• Employee Health and Safety Handbook
• Information about health and safety meetings
• Process for employee H&S representation
Demonstrate and ensure familiarity with:
• Location and use of fire extinguishers
• Use and maintenance of any relevant health and
safety equipment
• Location of emergency exists
Discuss health and safety responsibilities:
• in job description
• in the Health and Safety Manual
Organise training (as applicable):
• OOS prevention
• First aid 1
• Other (specify):
Employee
Signature &
Date
Manager
Signature &
Date
The {CEO} will ensure the induction training is recorded and verified in the employee’s
training records.
Name of employee: …………………………………………………………………………
Date: …………………………………………………………………………………………
1
It is the responsibility of the employee to provide {organisation name} with a copy of their First Aid
Certificate (if training is undertaken) and keep the certificate current. Renewal should be tracked through
Outlook Express to ensure certificates are renewed.

42
Appendix 4
Event management risk profile template
Step 2 Step 3 Step 4 Step 5
Risks Cause Risk controls
Actions required By whom When
Risk No.
Impact
Likelihood
Risk level
Risk
acceptable
What can
go wrong
or what
opportunities
might be lost?
What are we
doing to prevent
the risk event
from occurring?
List the specific
actions that need
to be taken to
better manage
the risk
These may
include:
– revising targets
– more frequent
monitoring
Name the
person
responsible for
each specific
action
Indicate
the date
completed by
Extreme
Major
Moderate
Minor
Insignificant
Almost certain (80%+)
Likely (60-79%)
Moderate (30-59%)
Unlikely (5-29%)
Rare (

HEALTH AND SAFETY
APPENDIX 5
43
Appendix 5
Sample health and safety manual
{Insert your organisation’s name and logo here}
Health and safety policies
and procedures manual
CONTENTS
Employer commitment and policy
Hazard management
Occupational Overuse Syndrome prevention policy
Smoke-free working environment policy
Stress at work
Manual handling
Accident management
Rehabilitation policy
Emergency management
First aid
Employee information, training and supervision
Workmen on site (contractors)/visitors
Appendix 1: Checklist for yearly manual review
Appendix 2: Checklist for ACC Safe Workplace Preparation Audit
Appendix 3: Sample workstation assessment checklist
Appendix 4: Incident and accident reporting form/register
Appendix 5: First aid register
Appendix 6: Hazard register
Appendix 7: Hazard notification form
Appendix 8: Bomb threat checklist

44
Employer commitment and policy
Purpose
This section lists the objectives of the health and safety manual, provides a brief
summary of the health and safety legislation and defines accountabilities.
Objectives
The {organisation name} health and safety programme aims to:
• promote excellence in health and safety management
• continually improve current health and safety performance
• provide a safe and healthy work environment
• identify and control actual and potential hazards
• establish and maintain communication on health and safety
• support staff participation in health and safety matters
• identify needs and provide training on health and safety
• demonstrate a commitment to the accurate reporting and recording of
health and safety matters
• comply with legal and organisational obligations.
Objectives will be achieved through:
• management’s support and commitment to health and safety
• implementation of policies and procedures
• implementation of an annual health and safety programme Plan 1
• staff education and participation
• maintaining a quality philosophy
• regular reviews and evaluations
• three-monthly health & safety meetings
• two-yearly health and safety manual review.
Legislative requirements
The Health and Safety in Employment Act 1992 requires employers to take all
practicable steps to ensure the health and safety of staff members at work by:
• providing a safe working environment
• providing and maintaining facilities for staff members’ safety and health
• ensuring plant and equipment on the premises are safe
• ensuring staff members are not exposed to hazards
• developing emergency procedures
• ensuring that no action or inaction by staff members is likely to cause harm
to themselves or any other person.
1
An annual plan is developed and can be found with Health and Safety Meeting Minutes at
the back of this manual.

HEALTH AND SAFETY
APPENDIX 5
45
Other people who have duties under the Act include persons in control of places of
work; self-employed people; principals to a contract; contractors and subcontractors;
and staff members.
The Health and Safety in Employment Regulations 1995 impose duties on employers
in respect of the workplace, certain staff members, and types of work. The Resource
Management Act, the Building Act, the Fire Service Act, the Hazardous Substances and
New Organisms Act, and the Injury Prevention, Rehabilitation, and Compensation Act
also include health and safety elements.
Accountability
The {CEO} as the employer representative has ultimate accountability for the health
and safety of all staff. This is provided for by:
• Demonstrating continuous improvement through a systematic approach
to occupational health and safety matters that includes setting specific
objectives, systems and programmes in partnership with staff and
reviewing these yearly (refer appendices 1 and 2).
• Documenting and communicating the health and safety policy and
holding staff members responsible for supporting the policy and related
procedures.
• Taking appropriate actions (including disciplinary actions) in the event
of unacceptable performance or behaviour, consistent with normal
operational practice.
• Incorporating health and safety as an element in position descriptions and
as a measurable outcome of an individual’s performance appraisal where
appropriate.
• Expecting all staff to share the responsibility for meeting the requirements
of health and safety legislation and maintaining ongoing accountability
through the roles and responsibilities defined below.
The Administrator {CEO or delegated manager} has key responsibilities for
developing, implementing and improving the health and safety management system as
an integral part of day-to-day operations. These include the following:
• providing leadership and direction in matters of health and safety
• developing staff commitment to achieving excellent health and safety
standards
• establishing, monitoring and achieving overall health and safety goals and
objectives
• ensuring that all staff members receive appropriate induction training, and
are involved in the improvement of systems and practices where relevant
(refer appendix 3 at the back of the employee health and safety handbook)
• ensuring health and safety representatives receive appropriate training (for
courses available from the employment relations service, see the website
www.ers.dol.govt.nz)
• conducting regular health and safety inspections
• maintaining up-to-date information on changes to health and safety
legislation, regulations, codes of practice and standards
• acting in the capacity of the health and safety representative
• ensuring any changes to the health and safety manual are distributed to
staff and the manual is kept up to date and is managed as a controlled
document.

46
Health and Safety Meetings
• Three-monthly health and safety staff meetings are to be held.
• The health and safety committee (representatives or team) comprises:
– {Enter in names of staff}
– {Enter in names of staff}
– {Enter in names of staff}
– {Enter in names of staff}.
• Employees will be involved in the selection of health and safety
representative members through informal discussion and agreement
at a general staff meeting. Any employee wanting to be on the health
and safety committee may self-nominate and will as a result be invited
to attend the committee meetings. Changes to the committee will be
communicated via email to all staff.
• Any employee is welcome to attend a health and safety committee
meeting.
The date and time of meetings will be circulated to all staff via group email.
• An extraordinary meeting will be held in the event of a serious harm injury
being investigated.
• The health and safety manual will be reviewed two-yearly by the {CEO} in
consultation with staff and in conjunction with ACC self-assessments.
Employee Consultation
Staff are encouraged to actively participate in health and safety meetings.
Where changes to existing policies are being considered, staff will be invited to
comment and participate in the consultation process prior to implementation of
changes.
Staff may have their nominated representative participate or advocate on their behalf
as part of the consultation process.
References
The Health and Safety in Employment Act 1992 and Amendment
The Health and Safety in Employment Regulations 1995
Other relevant regulations and codes of practice
Employee Health and Safety Handbook

HEALTH AND SAFETY
APPENDIX 5
47
Hazard management
Purpose
To further improve the method for systematically identifying, assessing and controlling
hazards in the workplace as required by the Health and Safety in Employment Act 1992.
Scope
The procedures apply to all {organisation name} activities.
Responsibilities
The {CEO} is responsible for:
• conducting regular health and safety inspections
• maintaining the hazard register (appendix 6) including identification and
risk analysis
• working with staff to control identified hazards
• authorising specialist consultants to be contracted where existing staff
competency is not available to identify, eliminate or minimise hazards (for
example assessment of workstations).
All staff are responsible for:
• implementing hazard management procedures in their work area
• taking all practicable steps to ensure that hazards identified are eliminated,
isolated or controlled
• completing a hazard notification form (appendix 7) if a hazard is identified
and providing this to the CEO (who will undertake a full identification and
risk analysis and enter details into the hazard register)
• informing others (staff, visitors and contractors) of any hazards to health
and safety which are known to be associated with the work they perform
and the steps to be taken to control any such hazard
• ensuring unsafe acts and unsafe conditions are appropriately addressed.
Procedure
Hazard management steps include:
1. Identification – describe the hazard and state the location of the hazard
2. Risk analysis – rate the risk
3. Control – Recommend the control measure (eliminate, isolate or minimise).
Complete details on the hazard management register (appendix 6).
If difficulties are experienced in identifying, eliminating or controlling hazards, the {CEO}
will engage an outside contractor with appropriate experience (e.g. BWA Group).

48
Hazard management needs to be completed:
• systematically for all areas and processes at regular three-monthly intervals
• when an accident occurs; a check is needed to ensure hazards listed and
their controls are adequate
• when a new process or equipment is introduced
• if a new hazard is observed or reported.
Step 1 – Identify hazards
Hazard Identification Process 2
1. Use inspection, audits, walk-through surveys and checklists to determine hazards
Working Environment
Area used and its physical
condition
Workplace layout
Location of material/
equipment and distances
moved
Types of equipment used
Energy hazards
Hazards which could cause
injury
Characteristics of materials,
equipment
Hazards which could cause
ill health
Psycho-social environment
Organisation environment
Human Factors
Knowledge and training
Skills and experience
Health, disabilities, fitness
Age and body size
Motivation
Risk perception and value
systems
Protective clothing, equipment,
footwear
Leisure interests
Tasks
Task analysis
Working postures
and positions
Actions and movements
Duration and frequency of
tasks
Loads and forces involved
Intensity
Speed/accuracy
Originality
Work organisation
2. Analyse any ‘near miss’ accidents that may have been recorded in the incident and accident
register or documented in the minutes from health and safety meetings
Step 2 – Risk analysis
Risk analysis is the process of estimating the magnitude of the risk and deciding what
actions to take. The following considerations are made to establish risk using the
likelihood and impact scales below.
2
Table: Adapted from Interaction of people, tasks, and environment for hazard analysis (developed from
Hay 1992, and OSH 1991: P10) Likelihood scale.

HEALTH AND SAFETY
APPENDIX 5
49
Score Scale Frequency of accident or illness
1 Rare May occur only in exceptional circumstances, e.g. less than 5%
chance of occurring
2 Unlikely Could occur at some time, e.g. 5-29% chance of occurring
3 Possible Should occur at some time, e.g. 30-59% chance of occurring
4 Likely Will probably occur in most circumstances, e.g. 60-79% chance
of occurring
5 Almost certain Will occur in most circumstances, e.g. 80%+ chance of occurring
Impact scale
Score Scale Severity of accident or illness
1 Minimal Negligible injury or illness
2 Minor Minor injury or illness requiring minor first aid and/or less than one
week’s recovery
3 Moderate Injury or illness requiring advanced first aid and medical visit (e.g.
GP or hospital visit) and/or 1-6 weeks’ recovery
4 Major Injury or illness requiring advanced first aid and emergency
medical assistance (e.g. hospitalisation) and/or more than six
weeks’ recovery
5 Extreme Injury or illness requires immediate emergency medical assistance
and may result in permanent or long-term disabling effects or
death. Hospitalisation likely to be for more than six weeks
A risk assessment category (critical, high, moderate or low) for each hazard is compiled
by using the chart below. Hazards with the highest rating are given priority.
Risk assessment chart
Likelihood
Almost
certain
Impact
Minimal Minor Moderate Major Extreme
H H C C C
Likely M H H C C
Possible L M H C C
Unlikely L L M H C
Rare L L M H H
Legend:
C
H
M
L
Critical risk; immediate action required
High risk; senior management attention is needed
Moderate risk; management responsibility must be specified
Low risk; manage by routine procedures
The risk assessment category is entered into the Risk Score column beside the hazard
on the Hazard Management form. ‘Significant Hazards’ are identified according to the
definition above.

50
Step 3 – Control
Where a significant hazard is to be controlled, this must, if practicable, be by
elimination. Where elimination is not practicable then the hazard must be isolated.
Only where both elimination and isolation are not practicable are methods of
minimisation to be applied.
If a minimisation strategy is used, the Act requires monitoring of employees’ exposure
to the hazard. In this event, a schedule should be developed and implemented
whereby the Health and Safety Representative {CEO} regularly monitors 3 the hazard
noting variances and taking appropriate action where necessary (such as obtaining
expert advise).
Definitions
• ‘Hazard’ means an activity, arrangement, circumstance, event, occurrence,
phenomenon, process, situation or substance (whether arising or caused
within or outside a place of work) that is an actual or potential cause or
source of harm. In effect a hazard can be interpreted as anything that can
cause harm in terms of human injury or ill health, damage to property,
damage to the environment or a combination of all these.
• ‘Hazard Identification’ is the process of recognising that a hazard exists
and defining its characteristics.
• ‘Hazard Assessment’ is the overall process of determining whether a
hazard is significant.
• ‘Significant hazard’ means a hazard that is an actual or potential cause or
source of:
– Serious harm; or
– Harm (that is more than trivial) the severity of whose effects on any
person depends on the extent or frequency of the person’s exposure to
the hazard; or
– Harm that does not usually occur, or is not easily detectable, until a
significant time after exposure to the hazard.
• ‘Harm’ means ‘illness, injury or both’. The term is only used in the context
of harm that is more than trivial.
• ‘Serious harm’ is essentially a work-related injury, illness or condition that
will result in admission to hospital for 48 hours or more or being off work
for more than one week.
References
The Health and Safety in Employment Act 1992 and Amendment
3
Through a prescribed timetable, for example undertaking a regular survey or internal audit.

HEALTH AND SAFETY
APPENDIX 5
51
Occupational Overuse Syndrome
Prevention Policy
Policy statement
Occupational Overuse Syndrome (OOS) is a collective term for a range of conditions
(including injury) characterised by discomfort or persistent pain in muscles, tendons and
other soft tissues. Every case of OOS has the potential to be classified as a significant
hazard because the condition may cause ‘Serious Harm’. Therefore the risk factors
for OOS need to be controlled by eliminating the hazard if at all possible, or else by
isolating or minimising the hazard.
Scope
This policy applies to all staff members of {organisation name}.
Purpose
To provide systems and procedures for proactively managing the risk factors that may
contribute to a range of occupational overuse type conditions.
Responsibilities
The {CEO} is responsible for:
• taking all practical steps to ensure that there is compliance with the OSH
Code of Practice (COP) for Visual Display Units 4
• ensuring all staff at risk attend an OOS awareness training session in their
first month of employment and as may be required
• encouraging staff to report any work-related pain to the {CEO} as early
as possible
• ensuring the work environment of any staff who do develop symptoms is
monitored and all practicable steps are taken to remedy any deficiencies
• facilitating an early return to work for any staff member who has been
absent through an OOS-related injury where possible.
Staff members are responsible for:
• reading the OOS awareness information and attending training where
required
• adjusting workstation equipment to maintain a comfortable body position
• taking breaks away from the workstation and practising micro-pauses
as appropriate
• reporting early symptoms to the line manager (preferably before visiting
a doctor)
• participating in an early return to work programme if applicable.
4
Laptop computers should not be chosen for continuous use at work unless they are plugged into a
conventional monitor and/or keyboard.

52
Procedures
Pre-employment procedures
Managers will seek to establish if the prospective staff member suffers from any
gradual process injury that the particular job may aggravate or contribute to, by
checking the statement on the application form.
Existing staff
• Individual staff members should adjust their own workstation to maintain
a comfortable working position, vary tasks, practise micro-pauses and
take other breaks. They must report any problems to the health and safety
representative, who in turn may request a full workstation assessment from
a properly trained Workstation Assessor. The Workstation Assessor will
work with the staff member to recommend changes or adjustments, and
will provide a brief summary of findings to the employee and {CEO}. (An
example of a workstation assessment form is provided in appendix 3.)
• Early warning symptoms should not be ignored in the hope that the
pain will go away. If discomfort during work activities persists for more
than a few days the following actions should be taken. By taking these
steps individuals will be making important decisions about stopping the
symptoms from worsening and developing into a possibly serious and longterm
condition.
Standards
Approved Code of Practice for the Use of Visual Display Units in the Place of Work;
Guidelines to the Selection and Purchase of Workstation Furniture and Equipment.
Definitions
The Health and Safety in Employment Act defines Serious Harm (in part) as
“a condition that amounts to or results in permanent or temporary severe loss
of bodily function”.
References
The Health and Safety in Employment Act (1992) and Amendment
The current Approved Code of Practice for the Use of Visual Display Units in the Place
of Work published by the OSH service of the Department of Labour
Guidelines to the Selection and Purchase of Workstation Furniture and Equipment
The Accident Reporting and Rehabilitation Policy
Record of Accident/Incident/Serious Harm

HEALTH AND SAFETY
APPENDIX 5
53
Smoke-free working
environment policy
Policy statement
It is a requirement of the Smoke-free Environments Act 1990 that all employers have
a written policy on smoking for all areas occupied by the employer and frequented
by employees.
{Organisation name} management recognise that the use of tobacco and smoking
presents a health hazard that can have serious implications for both the smoker and
the non-smoker and that smoking habits may have life-long adverse consequences.
{Organisation name} supports a safe and healthy environment.
Scope
This policy applies to employees of and visitors to {organisation name}.
Purpose
This policy was developed to meet the requirements of the Smoke-free Environments
Act 1990 and the Smoke-free Amendment Act 2003 and is based on the following
principles:
1. Everyone is entitled to a smoke-free environment in all the areas normally used
for work.
2. Everyone who does not smoke, or who does not wish to smoke in their place
of work, must, as far as is reasonably practicable, be protected from tobacco
smoke in their place of work.
3. The implementation of this policy depends on everyone responding courteously
to the desire for a smoke-free environment.
Responsibilities
The {CEO} is responsible for:
• The maintenance of smoke-free signage.
Procedure
Smoke-free buildings:
Smoking in buildings is prohibited as it endangers the safety of others, creates an
unhealthy environment and causes damage to property.
In the event that an employee chooses to smoke, a designated area, such as a
sheltered balcony outside of the premises, should be used.

54
Passive smoking:
Smoking is permitted in outside areas, provided others are protected from smoke drift
and passive smoking by the smoker keeping their distance from people, and opening
windows and doors within their close proximity.
Complaints:
Complaints regarding smoking and suggestions or complaints regarding a smoke-free
environment should be brought to the attention of the {CEO}.
References
Smoke-free Environments Act 1990
Smoke-free Amendment Act 2003

HEALTH AND SAFETY
APPENDIX 5
55
Stress at work
Policy statement
{Organisation name} recognise the responsibility of the employer to actively reduce
and manage stress in the workplace. Stress may arise from both personal and
organisational sources.
{Organisation name} clearly has a degree of control only over the latter, and these
guidelines provide a framework for stress management in the workplace.
Background information for employees
“Stress arises when a person’s capabilities are overwhelmed by demands” 5
Every day, individuals are confronted with a variety of demands or ‘stressors’. These
may arise from either personal sources e.g. ill-health, marital discord, family problems,
financial uncertainty, or from institutional sources e.g. work overload or underload,
role conflict, lack of control, physical environment. Stressors produce a biochemical
response in the body which prepare the body to do what is essential during a stressful
situation (in preparation for fight or flight).
The stress response is highly functional and can lead to elevated performance, through
constructive and creative responses, increased and well-directed energy, improved
morale and motivation, and increased efficiency and effectiveness. Where an individual
is exposed to demands that are too intense, frequent or chronic, the stress response
can create unhealthy, destructive outcomes, e.g. cardiovascular disease or depression.
There are wide individual differences in the way we each respond to stressors, and
therefore the optimum stress load that maximises performance varies by individual and
by task. (The Yerkes-Dodson Law refers to the fact that performance increases with
increasing stress loads up to an optimum point, and when the stress load becomes too
great, performance decreases.)
Some common signs of stress in individuals are:
• headaches, feeling tired, or having difficulty sleeping
• worrying a lot, feeling anxious and tense for no explained reason
• having difficulty concentrating, finding it hard to make decisions
• lower level of confidence, making mistakes, forgetting things
• feeling impatient and irritable, drinking more alcohol, smoking more.
“Stress is inevitable: distress is not” 6
5
Professor Michael O’Driscoll.
6
Quick J.C., Quick J.D., Nelson D.L., & Hurrell Jr J.J., Preventive Stress Management in Organizations 1997.

56
Organisational stressors can be grouped into four categories:
Scope
• Physical – the physical environment in which one works, e.g. temperature,
office design, noise, lighting etc.
• Task – the nature of the work itself, the specific activities assigned to the
employee, e.g. reception, budget management.
• Role – the expectations that others have of one’s role and its function
within the organisation, e.g. conflicting or ambiguous expectations.
• Interpersonal – the social, personal and working relationships that exist.
This policy is applicable to all staff.
Purpose
• To assist all staff to understand the causes of stress, and work together in
ways that encourage positive responses to work demands.
• To enable staff to identify indicators or symptoms of stress and to assess
the extent to which they or other individuals are responding positively or
negatively.
• To encourage managers and staff to seek information and early assistance
in managing their own stress in a constructive way.
• To provide information and advice regarding the causes and impact of
stress in the work situation, and offer some ways for managing stress
positively.
• To have procedures for dealing with negative stress or distress effectively.
Responsibilities
The {CEO} is responsible for:
• facilitating training and information for managers in effective management
practices and styles, covering the nature of stress, and promoting
responsible prevention and rehabilitation attitudes towards it as
determined by the {CEO}
• providing up-to-date and accessible information on stress
• adjusting the physical environment, the workload, task design, pacing
of work and work schedules to alleviate significant stress/distress for an
individual, in full consultation with the individual concerned
• making free specialist counselling available for staff.
Prevention
• allow staff to participate in collaborative decision-making.
• allow staff to exercise as much autonomy and control as is practical.
• provide training to enable work to be done most effectively.
• provide accurate, fair and prompt feedback on performance
• consider job design, job descriptions and performance targets with the aim
of reducing unnecessary stressors.
• consult with employees to identify stressors in the workplace.

HEALTH AND SAFETY
APPENDIX 5
57
• Promote activities that make the workplace healthier, more stimulating and
more fun.
• Carefully match people to jobs by considering their individual skills,
capabilities and needs.
Early intervention
• Act immediately if a staff member seems overly stressed.
• Explore whether their stress is in any way job related, discuss ways of
alleviating it in the short term initially, and then focus on the sources of
stress to consider long-term solutions.
• Short-term solutions could include sharing tasks amongst other staff,
taking leave, or adopting flexible or reduced hours.
• Long-term solutions should aim to eliminate or minimise the cause of stress
where possible – the preventative strategies outlined above should be used.
All staff are responsible for (where applicable):
• managing your time and realistically prioritising tasks
• taking regular, necessary breaks during the day
• taking your annual leave
• taking leave accrued as time in lieu as soon as practicable
• not working excessively long hours
• discussing with your manager the issues that are causing you stress, along
with any suggested solutions
• seeking advice and help from others – talk to partners, friends, colleagues,
a professional counsellor or your manager if possible.
References
The Health and Safety in Employment Act 1992 and Amendment

58
Manual handling
Purpose
To provide a starting point for the identification, assessment, prevention and control
of the hazards and risks associated with manual handling in the workplace.
Scope
The policy is applicable to all employees.
Responsibilities
The {CEO} is responsible for:
• identifying the manual handling tasks that are likely to be a risk to health
and safety, in the office workspace, re-assessing the risks on a regular
basis, taking steps to control those risks, and reviewing the effects of
controls. The code of practice for manual handling provides a method that
can be used to analyse such tasks in order to establish the healthiest and
safest ways of preventing harm to staff members
• providing information and training for staff about the hazards they are
exposed to or that they may create and what controls are in place.
Staff members are responsible for:
• taking all reasonable and necessary precautions for their own health and
safety (and that of others), when carrying out manual handling tasks
• being familiar with current accepted best practice for manual handling,
including use of equipment.
Definitions
The Code of Practice for Manual Handling published jointly in June 2001 by OSH and
ACC defines manual handling as:
“any activity requiring a person to lift, lower, push, pull,
carry, throw, move, restrain, hold, or otherwise handle any
animate, or inanimate object”.
Sources of further information
Information relating to manual handling can be found in the following:
Code of Practice for Manual Handling OSH (Department of Labour and ACC)
Manual Handling Hazard Control Record (Worksheet, OSH and ACC)
Manual Handling: A Work Book (Department of Labour)
Helpful Advice on Managing Your Acute Low Back Pain (ACC)
Active and Working (National Health Committee and ACC)
Acute Low Back Pain Management (National Health Committee and ACC)
The following websites have further information that can be downloaded free:
www.osh.dol.govt.nz and/or www.acc.co.nz

HEALTH AND SAFETY
APPENDIX 5
59
Accident management
Policy statement
A safe and healthy work environment is fostered through a partnership where all
involved combine their efforts and share the responsibility for work-related personal
injury prevention and management. Early reporting is essential to this process and
{organisation name} has a specific accident reporting and investigation form that must
be used in the event of all work accidents, incidents and OOS type conditions.
A staff member injured at work who needs medical treatment must provide
{organisation name} with a copy of the completed ACC forms, and, if time off work is
also required, must provide a medical certificate.
Scope
This policy applies to employees of {organisation name}, including fixed-term, part-time
and casual staff.
Purpose
To provide consistent procedures for recording and investigating work-related incidents
and accidents and to set out the work-related personal injury claim process.
Responsibilities
To assist {organisation name} in meeting its aims in the prevention and management
of work-related personal injury, there are responsibilities for the employer through line
managers working in partnership with employees.
The {CEO} is responsible for:
• preventing accidents and injury by providing a safe and healthy work
environment within their areas of office operation
• taking all practicable steps to see that all staff are aware of the accident
reporting system, know where to obtain the appropriate form, and report
such events when they occur
• arranging for appropriate first aid and emergency care (or other assistance)
where required if an accident does occur
• ensuring that weekly compensation payments are paid during any period
of incapacity
• acting as the health and safety representative, including liaison with ACC
and investigation of workplace injury or accident.
Staff members
Every staff member is responsible for:
• observing any established health and safety procedure that relates to the
work performed
• participating in relevant health and safety training, e.g. OOS prevention,
manual handling
• accurately reporting and documenting all accidents, incidents and observed
hazards to the {CEO}

60
• obtaining initial medical treatment from a registered treatment provider of
his/her choice (this must be a registered medical practitioner if lost time is
involved)
• providing a copy of the completed ACC forms and, if lost time is involved,
a medical certificate from the registered medical practitioner, to the {CEO}
• reporting non-work injuries resulting in time off to the {CEO} as soon as
possible.
Procedures
Pre-employment injury prevention procedures
The person or agency responsible for recruitment will check information provided as
part of the application process to ensure that prospective staff members have stated
that they are physically and medically fit to perform the duties of the position for which
they have applied before appointment is finalised.
Record of accident/incident/serious harm
The Health and Safety in Employment Act places requirements on employers to record
and investigate accidents. “Serious harm” accidents must be reported, in writing, and
on the prescribed form, to the Occupational Safety and Health Service (OSH) of the
Department of Labour, within seven days of the event.
The purpose of the investigation procedure is to determine actual causes of an
accident/incident and to put in place procedures or controls to minimise the chances of
a recurrence.
The {organisation name} accident/incident/serious harm form (appendix 4)
Notification of work-related 7 accidents/incidents and how to make
a claim
Whenever there is a work-related accident, incident or ‘Serious Harm’ injury the staff
member must take the following steps:
• Inform the {CEO} as soon as possible after the accident/incident occurs.
• Complete an accident/incident/serious harm form, and send a copy to
{organisation name} immediately.
• If medical treatment is required and/or there is lost time, the staff member
must, in addition to completing the form above, seek treatment from
a treatment provider of their choice. (This must be a registered medical
practitioner if lost time is involved.) ACC forms will need to be completed.
• Provide copies of any completed ACC forms (and a medical certificate if
lost time is involved) to the {CEO} as soon as possible.
7
Affecting the employee.

HEALTH AND SAFETY
APPENDIX 5
61
Accident/Incident reporting investigation
In the event of ‘serious harm’ or a significant hazard the {CEO} must be advised
immediately so that OSH can be advised.
The {CEO} should:
• ensure receipt of all relevant information (incident form, ACC forms,
medical certificates as applicable)
• initiate and carry out an investigation. This must commence within 12
working hours of the event concerned
• ensure any hazard that is identified as the cause of the event is eliminated,
isolated or minimised in accordance with the requirements of the Health
and Safety in Employment Act
• ensure all corrective actions that have been identified are carried out within
the specified timeframes
• the investigation report will be reviewed by the {CEO} to ensure that the
corrective actions have been carried out as indicated and to check, if
applicable, that significant hazards have been controlled in accordance
with the requirements of the Act.
When events result in ‘serious harm’, take the following steps:
• Make sure anyone injured or suspected of injury has received medical
attention if necessary.
• Do not interfere with the accident scene without the permission of
an Inspector from the Occupational Safety and Health Service of the
Department of Labour (OSH).
• Complete the reporting and investigation procedures and take steps to
eliminate, isolate or minimise any identified significant hazards. The injured
person must also provide a medical certificate from the treatment provider
and forward it to the health and safety representative or CEO.
• OOS type conditions may become ‘serious harm’ and must be reported to
OSH (via the {CEO}) if the following conditions are met:
– The person is suffering from pain which is significantly more than
discomfort, and considers it work related.
– The person is unable to carry out, or is directed not to carry out,
normal duties for a period of more than seven calendar days,
irrespective of whether they take sick leave.
– The person has voluntarily obtained, or been directed to obtain,
medical help for the condition.
– A diagnosis of an OOS type condition that is or could be work related
is made by a medical practitioner.

62
Definitions
• ‘Work-related personal injury’ is a personal injury that the staff
member suffers as set out in the Injury Prevention, Rehabilitation, and
Compensation Act. This includes a definition of personal injury caused by a
work-related gradual process, disease or infection.
• ‘Lost time accidents’ are work-related personal injuries that result in more
than a day off the job (i.e. the staff member is unable to resume work the
day after a personal injury has occurred).
• ‘Treatment provider’ means a registered medical practitioner if time
off work is required, or a registered health professional such as a
physiotherapist, chiropractor etc. if time off work is not necessary.
References
Injury Prevention, Rehabilitation, and Compensation Act 2001
Privacy Act 1993
Human Rights Act 1993
Health and Safety in Employment Act 1992 and Amendment

HEALTH AND SAFETY
APPENDIX 5
63
Rehabilitation policy
Policy statement
{Organisation name} is committed to initiating vocational rehabilitation programmes
whenever appropriate for work-related personal injury (all staff) and for non-work
personal injury (excludes contracted staff who fall outside the definition of ‘employee’).
The aim is to assist optimum recovery, early return to work and resumption of normal
lifestyle without undue delay. The benefits of rehabilitation are greatest when the
process is begun as soon as possible.
Staff are expected to participate fully in their own rehabilitation programme which
will be established through a consultative approach. The injured person is entitled to
support, advice and representation from their nominated representative 8 . Medical
information will be obtained with formal consent from the staff member and will be
treated confidentially.
Purpose
Through planned rehabilitation, to manage proactively the early return of staff
members to as normal a life as possible, having regard to the consequences of the
personal injury.
The {CEO} is responsible for:
• identifying suitable alternative duties, where possible, to enable an early
return to work for the staff member
• confirming that a rehabilitation plan is established, if appropriate, following
a lost time accident
• monitoring the staff member’s progress towards recovery and the
suitability of the alternative duties and/or rehabilitation programme
• taking steps to see that appropriate levels of confidentiality are maintained
consistent with the principles of the Privacy Act 1993
• reviewing health and safety management after a critical event, or if there is
a change in work procedures or health and safety policy
• acting as the health and safety representative and person responsible for
liaison with ACC on behalf of your organisation.
Staff members are responsible for:
• participating in an appropriate rehabilitation programme, including a return
to work programme which requires alternative duties or partial hours
• providing ongoing medical certificates to the {CEO}.
8
For example, friend, colleague, union representative

64
Rehabilitation procedure
Early return to Work for full-time and part-time employees
A staff member who has experienced work-related personal injury and who has
taken time off to recover will be supported in a return to work as early as possible
and in accordance with medical advice. This involves a partnership between the staff
member and the {CEO}, medical treatment providers and others as appropriate in the
circumstances. At any stage the staff member can choose to be accompanied by a
representative or support person. An early return to work may involve a modification
of the person’s working environment, alternative duties for a temporary period, and/or
changes to the normal hours of work.
Medical information
The staff member must give a copy of their completed ACC forms, or medical
certificate, from the treatment provider (this must be a registered medical practitioner
if lost time is involved), to the {CEO}.
The medical certificate will state the staff member’s capacity or incapacity for work
and specify a date for review (second visit) by the treatment provider. Selected or
restricted activities may also be specified for a certain period of time. If the injured
person is off work for more than seven consecutive days they must provide a medical
certificate confirming they are ‘fit for work’ to the {CEO}.
Capacity to work and the provision of alternative duties
The provision of suitable alternative duties is an essential part of rehabilitation.
Alternative duties are aimed at providing appropriate and productive work while a staff
member rehabilitates to his/her former role. This is a proactive approach to enable a
staff member to return to work as quickly as possible and maximise the chances of
full recovery.
The {CEO}, in consultation with others as appropriate, will try to identify suitable
alternative duties after considering:
• the nature and severity of the illness/injury
• the medical information provided and the restrictions imposed by
treatment providers
• the previous work undertaken by the staff member
• the predicted timeframe for rehabilitation (if known).
Regular review
The {CEO} will review the rehabilitation programme in consultation with the staff
member at regular intervals (usually every two weeks) involving others as appropriate.
Where uncertainty exists about the suitability of duties being performed or where the
progress of a staff member is slower than anticipated, the {CEO} will seek additional
professional assistance as appropriate.
Alternative placement or permanent disablement
Where at any point it becomes clear that a staff member will be unable or is unlikely to
return to former duties as a result of work-related personal injury, {organisation name}
will explore the possibility of suitable alternatives with the employee.

HEALTH AND SAFETY
APPENDIX 5
65
When an employee’s personal injury is so severe as to prevent him/her returning
to their former position and all available options have been fully explored, then
termination of employment will be considered in accordance with the relevant
employment contract.
Definitions
• ‘Rehabilitation’ means a process of active change and support with
the goal of restoring the staff member’s health, independence and
participation to the maximum extent practicable. It comprises treatment,
social rehabilitation and vocational rehabilitation.
• ‘Rehabilitation plan’ means an individualised rehabilitation programme
to facilitate the early and safe return of the staff member to the same or
equivalent duties as those previously performed on a long-term basis.
• ‘Alternative duties’ are early return to work interventions. They may
include alternative work, or other forms of action appropriate for the staff
member. These duties are a temporary modification of the employee’s
work tasks. They must not aggravate the personal injury or delay healing,
must be compatible with the business of the organisation, and be subject
to regular review. A staff member may be fit for alternative duties from
the occurrence of the personal injury, or when improvement has occurred
following a period of being unfit for work.
• ‘Serious harm’ means harm resulting in a condition that amounts to or
results in permanent loss of bodily function, or temporary severe loss of
bodily function and/or any harm that causes the person to be hospitalised
for a period of 48 hours or more.
References
Injury Prevention, Rehabilitation, and Compensation Act 2001
Privacy Act 1993
Human Rights Act 1993
Health and Safety in Employment Act 1992 and Amendment

66
Emergency management
Policy
{Organisation name} recognises the need to be prepared for emergency situations
that may be encountered while at work.
Scope
This policy applies to all full-time and part-time {organisation name} employees
and contractors.
Responsibilities
The {CEO or other delegated person, e.g. H&S representative} is
responsible for:
• acting as the warden for {organisation name}
• ensuring all staff receive emergency preparedness training
• maintaining emergency supplies of water and provisions in accordance
with civil defence requirements
• maintaining a register of those staff who may require special assistance in
the case of an emergency requiring evacuation.
All staff are responsible for:
• maintaining familiarity with emergency responses and following procedures
• advising the {CEO} of any special assistance that may be required in case
of an emergency requiring evacuation (e.g. in case of deafness, physical
disability)
• ensuring their own safety if working in the building after hours or alone,
by utilising security measures that are available (e.g. doors electronically
locked).
Procedures
1. When emergency services are required
• For emergency services dial 1 for an outside line then 111 and ask for the
service you require:
FIRE
AMBULANCE
POLICE.
• Stay calm, give your name, details of the emergency, and street address -
which is
{Enter in organisation address here}
PHONE NUMBER {Enter in organisation phone number here}.
• Visitors
Visitors are the responsibility of the person they have called to see.

HEALTH AND SAFETY
APPENDIX 5
67
2. Fire
Ensure you are familiar with the building evacuation scheme or evacuation procedure.
If you discover a fire:
• activate the alarm and dial 111
• alert people in your area and the warden (the {CEO} is the {organisation
name} warden) or a health and safety representative in his/her absence
• do not extinguish the fire unless there is no personal danger to you or
anyone else
• if time permits and there is no danger, close all doors and windows
• evacuate the building following the evacuation procedure or scheme
• after evacuation meet at the assembly point.
If the fire alarm sounds:
• walk quickly to your nearest exit (do not use lifts)
• make sure any visitors leave the building with you
• do not stop to take personal items with you
• keep to the left of the stairs
• meet at the assembly area {specify where this is} and report to the building
or floor warden.
3. Earthquake
• Keep calm.
• Move away from windows, equipment and shelves that may fall.
• Take cover under solid furniture such as tables and desks.
• Do not try to evacuate until the shaking has stopped.
• Be prepared for aftershocks.
When the shaking stops:
• keep calm and help those who need assistance
• warden will turn off all electrical sources and gas taps
• wait for orders from your warden
• check for hazards and extinguish any fires if safe to do so
• evacuate if instructed to do so
• listen to the radio for civil defence instructions.
If you need to evacuate or the fire alarm sounds:
• use evacuation procedures to leave the building
• keep together
• follow the warden’s instructions
• meet at the assembly area {specify where this is}.

68
4. Flooding (in building, e.g. sprinklers)
• Shut off the power and water and turn off electrical appliances if there is
no personal danger to you or anyone else.
• Try to identify the source of the flooding if safe to do so.
• Contact the building manager {specify who this is and their contact details}.
• Prepare to evacuate.
5. Flood (Natural Disaster)
• Shut off the power and water and turn off electrical appliances if there is
no personal danger to you or anyone else.
• Move vital records to highest accessible point if safe to do so.
• Notify emergency services.
• Prepare to evacuate.
6. Unwanted visitor
If a person is displaying unusual behaviour:
• keep calm, make no sudden movements
• do what the offender asks
• try to memorise as many details about the offender as possible
• notify police as soon as it is safe to do so. Leave the phone line open until
police arrive.
7. Bomb threat
When a bomb threat is received, or a suspicious object is discovered, it must be treated
as genuine until proven otherwise.
Do not touch or move any suspicious object. Treat unusual or suspicious objects as a
bomb, as they can be made to resemble almost anything. The Police will determine the
action to take with the object.
• Keep calm.
• Keep the person talking – don’t interrupt.
• Let them feel in charge – keep the person on the line, don’t hang up.
• Ask Bomb Threat Checklist questions and record responses
(refer appendix 8).
• Do not operate the manual alarm points or electrical switches, or use a
mobile telephone as this may activate the device.
• Attract assistance if possible and have this person alert staff and notify Police
on 111.
• Evacuate the building if directed to do so by the Police (but do not hang
the phone up on the caller).

HEALTH AND SAFETY
APPENDIX 5
69
First aid
Policy statement
{Organisation name} has a responsibility to take ‘all practicable steps’ in providing
effective first aid arrangements.
Purpose
To ensure safe and consistent care is taken when first aid may be required in the
workplace.
Scope
This policy applies to all {organisation name} employees.
Responsibilities
The {CEO} is responsible for:
• ensuring appropriate first aid supplies are provided at the {organisation
name} office (see minimum list below)
• ensuring that first aid supplies are accessible to staff at the office
• being the designated first aid representative for {organisation name}
• holding an appropriate first aid certificate or other equivalent qualification
• ensuring a first aid register form and incident and accident register is
completed in the event that first aid is rendered (refer appendix 4 and 5).
References
The Health and Safety in Employment Act 1992 and Amendment
The Health and Safety in Employment Regulations 1995
Guidance Notes on Providing First Aid Equipment, Facilities and Training, OSH,
Oct 2000

70
Addendum
{organisation name} Office first aid supplies
Minimum contents for workplace first aid kits
• A manual giving general guidance on first aid
• 20 individually wrapped sterile adhesive dressings (various sizes),
appropriate to the type of work
• 2 sterile eye pads
• 2 individually wrapped triangular bandages
• 6 safety pins
• 6 medium-sized, individually wrapped sterile unmedicated wound
dressings, about 12 cm x 12 cm
• 2 large sterile individually wrapped unmedicated wound dressings,
approximately 18 cm x 18 cm
• 1 pair of disposable gloves
• 1 resuscitation mask.
Note: Pain relief should not be included in first aid kits. Special provision for treating
allergic reactions should be the responsibility of the person with the allergy.

HEALTH AND SAFETY
APPENDIX 5
71
Employee information,
training and supervision
Policy statement
{Organisation name} recognises the responsibility of the employer to promote a
safe and healthy workplace. Employees need to actively participate in workplace
health and safety and require information, training and supervision to support safe
workplace practices.
Purpose
To ensure that employees are provided with adequate information, training and
supervision on health and safety matters.
Scope
This policy applies to all {organisation name} employees.
Responsibilities
The CEO is responsible for ensuring that all newly appointed
staff receive:
• an induction to health and safety in the workplace (refer checklist,
appendix 3, Health and Safety Toolkit)
• a copy of the Employee Health and Safety Handbook
• an opportunity to complete the induction process and gain familiarity with
{organisation name} policies and procedures
• any additional training that is required as a result of specific work activities
or requirements
• any protective clothing or equipment required for the position
• adequate supervision to ensure a safe workplace including a workstation
assessment (refer checklist, appendix 3).
The CEO is responsible for ensuring that staff receive:
• opportunities for employees to contribute to health and safety
• notification of all health and safety meetings
• an opportunity to attend ongoing training in relation to health and safety
relevant to the organisation and employee responsibilities (for example,
health and safety representative training, first aid training).

72
All staff are responsible for:
• following instructions of your employer or employer representative
(e.g. supervisor)
• completing the induction process including reading the employee health
and safety handbook, policies and procedures and undertaking paid
training as directed
• reporting hazards
• using and caring for protective equipment or clothing provided by
the employer
• cooperating with the monitoring of workplace hazards and employees’
health (with permission)
• reporting work-related injuries or ill health
• not undertaking work that is unsafe
• not interfering with an accident scene.
References
The Health and Safety in Employment Act 1992 and Amendment
Employee Health and Safety Handbook

HEALTH AND SAFETY
APPENDIX 5
73
Workmen on site
(contractors)/visitors
Policy statement
{Organisation name} is firmly committed to the provision of a safe and healthy
workplace for contractors, sub-contractors and visitors in accordance with its
Occupational Health and Safety Policy and with its duties under the Health and Safety
in Employment Act 1992, and related legislation and regulations. In meeting these
requirements {organisation name} seeks to:
• ensure that contractors and subcontractors work in a healthy and safe
manner and are not harmed (or do not cause harm to others) while
working on {organisation name} premises
• promote measures to prevent injury and illness by insisting on safe
methods, safe equipment, proper materials and safe practices at all times
• ensure that all visitors are not harmed while on {organisation name}
premises.
Responsibilities
The reception staff {or other nominated person} is responsible for:
• ensuring details of any specific hazards that may be relevant to the visitor
and/or contract worker are provided to the visitor and/or contractor
• advising the contractor on miscellaneous matters, such as how to activate
the fire alarm, the location of fire extinguishers and first aid assistance,
escape possibilities, and where and to whom the contractor should report
in case of an emergency situation, or an accident
• advising visitors of any hazards and evacuation procedures in case of an
emergency and of the policy that they must be escorted at all times
• maintaining a record of visitors and contractors on the premises
and providing the contractor or any unescorted visitor with suitable
identification (ID badge)
• ensuring there are strategies for on-site communications for contractors
(e.g. site meetings).
Staff are responsible for:
• ensuring visitors are escorted by a staff member at all times (unless they
have been issued with a visitor ID badge) to ensure their safety and
wellbeing and assist that person if required should the building need to
be evacuated.

74
The contractor is responsible for:
• providing details of any hazards that they will be bringing onto the site
or any hazards that may be created as a result of the nature of the work
being undertaken, together with how these hazards will be mitigated
• ensuring the contractor’s employees have received the safety training
required for the specific job, including protocols for issuing keys or entry to
restricted areas
• providing and using emergency and personal protective equipment they
may require.
The visitor is responsible for:
• acting on the instruction of the {CEO} (or other nominated health and
safety Representative) in the case of an emergency
• advising the receptionist of any special assistance that may be required in
case of an emergency requiring evacuation.
References
The Health and Safety in Employment Act 1992 and Amendment
The Health and Safety in Employment Regulations 1995
The Fire Safety and Evacuation of Buildings Regulations 1992
Visitors, and Contractors, Registers

HEALTH AND SAFETY
APPENDIX 5
75
Appendix 1: Checklist for yearly manual review
Health & Safety
System
Employer
commitment
to health and
safety
Hazard
identification
and management
Accident
reporting and
management
Emergency
planning and
readiness
Employee
information,
training and
supervision
Employee
involvement
Contractors and
visitors
Event
management
Policy components
• Outline of Health and safety
programme (objectives)
• Employer commitment including
employer and employee responsibilities
• Volunteers
• Health and safety committees
• Acknowledgment of and crossreference
to relevant legislation
• Quality systems that support health
and safety such as internal audit
• Hazard identification process and
risk analysis
• Managing hazards
• Stress at work
• Occupational Overuse Syndrome
prevention
• Manual handling guidelines
• Smoke-free workplace
• Forms for hazard identification
and analysis
• Definitions of accident and serious harm
• Procedures for investigating and
recording accidents
• Making claims
• Rehabilitation – employer commitment
to vocational rehabilitation programmes
and early return to work
• Forms for recording accidents and
investigations
• First Aid
• Disaster management (fire,
earthquake, flood)
• Management of an unwanted visitor,
bomb threat
• Induction process & training
• Employee responsibilities
• Ongoing training and staff development
• Cross-references to employer
commitment
• Employee participation
• Cross reference to health and safety
committees
• Definitions
• Processes to ensure safety while on-site
• Responsibilities
• Health and safety off-site
• Responsibilities and functional
relationships with other stakeholders
• Checklists managing risk – event
management
Review date

76
Appendix 2: Checklist for ACC Safe Workplace Preparation Audit
Checklist to assist in preparation for the ACC Safe Workplace Audit to be used in
conjunction with the Self-Assessment Guide (ACC1663)
Questions Response Follow-up required?
(when & who by)
Who is your H&S Representative?
Has this person had recent training in H&S? (specify what
and when)
Do you have a visitors’ book or other mechanism for monitoring
and ensuring visitor safety?
Do you have a contractors’ book or other mechanism for
monitoring & ensuring contractor & staff safety?
Do you provide information to visitors & contractors of hazards
& emergency procedures? (How is this done?)
Do you obtain information from contractors about hazards they
may be bringing on-site?
Do you have a qualified first aid person? (When does their First
Aid Certificate expire?)
Do you have first aid supplies? (Are they current & complete?)
Have you identified hazards?
Do you have a hazards register? (Is this regularly updated?)
Have you had any expert assistance to identify or
mitigate hazards?
Have you had any incidents & accidents?
Have incidents & accidents been recorded?
What action has been taken as a result of incidents & accidents?
Have you had regular H&S meetings? (If yes, how often?)
Are there minutes of these meetings including who attended
& action plans where applicable?
Have you circulated any material relating to H&S in staff
newsletters or emails over the past year?
Have you any staff who are union members?
Have staff been informed that they are able to have a
representative or union representative assist them in relation
to the H&S matters?
Have staff participated in the review of any policies or
procedures relating to H&S?
Do you set yearly objectives for H&S?
Do you have a management plan of how these objectives will
be achieved?
Have you undertaken a review of objectives to monitor progress
toward achievement?
Do you have copies of H&S inspections of equipment
(e.g. of fire extinguishers) /fire drills etc?
Do you have a fire warden? (If yes, has this person had fire
warden training?)
Do you have reference material available to staff and H&S
matters in addition to any policies and procedures?
Is there an orientation or induction process for new staff that
includes H&S?
Are H&S responsibilities assigned to managers or the H&S
Representative written into the job description of those people?
Are H&S responsibilities included in the performance review
of staff?

HEALTH AND SAFETY
APPENDIX 5
77
Appendix 3: Sample workstation assessment checklist
After three months each new employee’s workstation should be assessed according to
the following checklist and adjustments made as required.
A
B
C
D
E
F
G
H
I
J
Working Conditions
The workstation should be designed or arranged so it allows the employee’s…
Head and neck to be about upright (not bent down/back)
Head, neck and trunk to face forward (not twisted)
Trunk to be about perpendicular to floor (not leaning forward/backward)
Shoulders and upper arms to be about perpendicular to floor (not stretched forward)
and relaxed (not elevated)
Upper arms and elbows to be close to body (not extended outward)
Forearms, wrists and hands to be straight and parallel to floor (not pointing up/down)
Wrists and hands to be straight (not bent up/down or sideways toward little finger)
Thighs to be about parallel to floor and lower legs to be about perpendicular to floor
Feet to rest flat on floor or be supported by a stable footrest
VDU tasks to be organised in a way that allows the employee to vary VDU tasks with
other work activities, or to take micro-pauses while at workstation
Seating
The chair…
1 Backrest provides support for employee’s lower back (lumbar area)
2 Seat width and depth accommodate specific employee (seat pan not too big/small)
3 Seat front does not press against the back of the employee’s knees and lower legs
(seat pan not too long)
4 Seat has cushioning and is rounded/has ‘waterfall’ front (no sharp edge)
5 Armrests support both forearms while employee performs VDU tasks and do not
interfere with movement
Keyboard / Mouse
The keyboard/input device is designed or arranged for doing VDU tasks
so that…
6 Keyboard/input device platform(s) is stable and large enough to hold keyboard and
input device
7 Input device (mouse or trackball) is located right next to keyboard so it can be
operated without reaching
8 Mouse is easy to activate and shape/size fits hand of specific employee (not too
big/small)
9 Wrists and hands do not rest on sharp or hard edge
Monitor
The monitor is designed or arranged for VDU tasks so that…
10 Top line of screen is at or below eye level so employee is able to read it without
bending head or neck down/back (For employees with bifocals/trifocals, see next
item)
11 Employee with bifocals/trifocals is able to read screen without bending head or neck
backward
12 Monitor distance allows employee to read screen without leaning head, neck or
trunk forward/backward
13 Monitor position is directly in front of employee so employee does not have to twist
head or neck
14 No glare (e.g. from windows, lights) is present on the screen which might cause
employee to assume an awkward posture to read screen
Y
Y
Y
Y
N
N
N
N

78
Work Area
The work area is designed or arranged for doing VDU tasks so that…
Y
N
15 Thighs have clearance space between chair and VDU table/keyboard platform (thighs
not trapped)
16 Legs and feet have clearance space under workstation so employee is able to get
close enough to keyboard/input device
Accessories Y N
17 Document holder, if provided, is stable and large enough to hold documents that are
used
18 Document holder, if provided, is placed at about the same height and distance
as monitor screen so there is little head movement when employee looks from
document to screen
19 Wrist rest, if provided, is padded and free of sharp and square edges
20 Wrist rest, if provided, allows employee to keep forearms, wrists and hands straight
and parallel to ground when using keyboard/input device
21 Telephone can be used with head upright (not bent) and shoulders relaxed (not
elevated) if employee does VDU tasks at the same time (i.e. using headset)
General Y N
22 Workstation and equipment have sufficient adjustability so that the employee is able
to be in a safe working posture and to make occasional changes in posture while
performing VDU tasks
23 VDU workstation, equipment and accessories are maintained in serviceable condition
and function properly
Comments
Passing Score = ‘YES’ answer on all ‘working postures’ items (A-J) and no more than
two ‘NO’ answers on remainder of checklist (1-23)

HEALTH AND SAFETY
APPENDIX 5
79
Appendix 4: Incident and accident reporting
form/register
Record of Accident /Incident/ Serious Harm
To be completed by the line manager and injured person and sent to H&S representative or
CEO within 48 hours of the event.
Is it an o Accident o Incident/Near Miss o Condition (e.g. OOS)
Surname: ………………………………………………………...
First name(s): …………………………………………………...
Residential address: ………………………………………….
………………………………………………………………………
………………………………………………………………………
o Disease nervous system
o Disease musculo-skeletal system
o Disease digestive system
o Disease infectious or parasitic
o Disease respiratory system
o Tumour (malignant or benign)
o Damage artificial aid
o Fatal
Phone: …………….………………………
Gender: o M o F
Date of event: ………………………Time: ………… am/pm
Date reported:……………………………………………………..
If OOS – date of visit to doctor:…………………………………
Hours worked since arrival at work.………………………….
Shift o Day o Evening o Night
Location where event occurred: ………………………………
……………………………………………………………………….
Occupation or position of injured person: ………………….
……………………………………………………………………….
Type of employment:
Injured part of body:
o Trunk o Neck
o Head o Internal organs
o Upper limb(s) o Lower limb(s)
o Multiple locations
Mechanism of event:
o Fall, trip or slip
o Sound or pressure
o Biological factors
o Body stressing
o Mental stress
o Being hit by moving objects
o Heat, radiation or energy
o Chemicals or other substances
o Hitting objects with part of
the body
Was a ‘Significant Hazard’ involved?
o Full-time o Part-time o Non-employee
o Yes
o No
Period of employment:
o 1st week
o 1st month
o 1-6 months o 7 months-1 yr
o 1-5 years
o Over 5 years
Nature of injury or disease:
o No injury
o Superficial
o Sprain or strain o Open wound
o Head injury o Poisoning/toxic effect
o Fracture, spine o Other fractures
o Multiple injuries o Foreign body
o Puncture wound o Internal injury, trunk
o Chemical reaction o Occupational hearing loss
o Burns
o Bruising/crushing
o Mental disorder o Amputation, including eye loss
o Nerves/spinal cord o Dislocation
o Disease skin o Disease circulatory system
Type of treatment given:
o Nil
o Doctor
Agency of injury:
o First aid
o Hospital
o Machinery or (mainly) fixed plant
o Mobile plant or transport
o Tools, appliances, equipment
(powered)
o Tools, appliances, equipment
(non-powered)
o Chemical or chemical products
o Material or substance
o Environmental agency
o Animal, human or biological
agency (not bacterial/virus)
o Bacterial or virus

80
THE INVESTIGATION: Describe what happened.
ANALYSIS: What caused the event?
PREVENTION: What action has or will be taken to prevent a recurrence?
By whom?………………………………………….………
…………………………………………………………..
By when?
Were ACC forms completed?
Has time been lost from work?
o Yes o No
o Yes o No
If yes, how many days?………………………………..…………
Manager (Name)…………….…………………….…………
……………………………………………………………
Signature
Date
Consent (in the case of an ACC claim)
I authorise the {CEO or Health and Safety Representative} to obtain medical and any other records
that are, or may be, relevant to this claim.
I authorise disclosure to any accident insurer of personal information and health information held by
other parties relating to the claim.
I authorise disclosure of my health and other information relating to this claim to: my employer, ACC,
contracted health or rehabilitation providers, employee representatives.
Injured Person: ……………………………………………………
………………………………………………………
Signature
Date

HEALTH AND SAFETY
APPENDIX 5
81
Appendix 5: First aid register
Employee’s name:
Job title:
Date of treatment:
Time of treatment:
Person giving first aid:
Accident register completed by:
Nature of injury:
Treatment provided:

82
Appendix 6: Hazard register
Hazard Identification and Analysis Action
Risk Category
Hazard and potential
harm
Significant
hazard?
Yes/No
Practicable to Controls required (including existing) Person responsible Date of
action
Eliminate?
Yes/No
Isolate?
Yes/No
Minimise?
Yes/No
Completed by

HEALTH AND SAFETY
APPENDIX 5
83
Appendix 7: Hazard notification form
Any employee who identifies a hazard should complete this form, for example a new
hazard that is not entered into the hazard register or an existing hazard that has been
entered into the hazard register that has not been correctly managed to eliminate or
mitigate risk.
Hazard Notification Form
Your name: Date: Location: Notification to:
Date observed:
Description of hazard including significance in
your opinion:
Any immediate action
taken to mitigate:
(please describe)
Your recommendations to
control or eliminate
the hazard:
Signature of person notifying this hazard:
Health and safety representative report including analysis and action taken:
Date entered into the hazard register:
Signature of health and safety representative:

84
Appendix 8: Bomb threat checklist
Question
Where did you put the bomb?
Response
What does the bomb look like?
What will make the bomb explode?
When is the bomb going to explode?
What is your name?
Where are you?
Record
Details
Record the exact wording of the threat
Date and time of call
Any distinguishing background noises
Sex of caller, estimated age

Level 4, Dominion Building, 78 Victoria Street,
PO Box 2251, Wellington, New Zealand
Phone: +64 4 472 8058 Fax: +64 4 471 0813
www.sparc.org.nz
87189 – 05/2006