WHS Performance Reporting Pack - Office of the Federal Safety

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WHS Performance
Reporting Pack
January 2015
ISBN
978-0-642-33281-3 [PDF]
978-0-642-33282-0 [DOCX]
With the exception of the Commonwealth Coat of Arms, the Department’s logo, any material protected by a trade mark
and where otherwise noted all material presented in this document is provided under a Creative Commons Attribution
3.0 Australia (http://creativecommons.org/licenses/by/3.0/au/) licence.
The details of the relevant licence conditions are available on the Creative Commons website (accessible using the
links provided) as is the full legal code for the CC BY 3.0 AU licence
(http://creativecommons.org/licenses/by/3.0/au/legalcode).
The document must be attributed as the Office of the Federal Safety Commissioner WHS Performance Reporting
Pack.
Contents
Section One ...................................................................................................................... 1
Introduction ............................................................................................................ 1
Scope ...................................................................................................................... 1
Why measure WHS performance? ........................................................................... 1
Why is it important to collect this information? ....................................................... 1
What happens to the information I provide?............................................................ 2
Submission, help and advice .................................................................................... 2
Overview of the Reporting framework ..................................................................... 3
Section Two...................................................................................................................... 4
Definitions .............................................................................................................. 4
Australian Government ....................................................................................... 4
Building work....................................................................................................... 4
Non-Scheme Project ............................................................................................ 4
Scheme Project .................................................................................................... 5
Section Three ................................................................................................................... 6
Frequently asked questions ..................................................................................... 6
Section Four ..................................................................................................................... 8
Guide for completing the OFSC Contract Declaration Form ....................................... 9
OFSC Contract Declaration Form ............................................................................ 13
Sample OFSC Contract Declaration Form ................................................................ 15
Guide for completing the Scheme Project Report ................................................... 17
Scheme Project Report .......................................................................................... 20
Sample Scheme Project Report .............................................................................. 22
Guide for completing the OFSC Incident Report ..................................................... 24
OFSC Incident Report ............................................................................................ 32
Sample OFSC Incident Report ................................................................................ 35
Guide for completing the OFSC Biannual Activity Report ........................................ 38
OFSC Biannual Activity Report ............................................................................... 44
Sample OFSC Biannual Activity Report ................................................................... 48
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
Section One
Introduction
This WHS Performance Reporting Pack details the reporting obligations of accredited contractors under the Australian
Government Building and Construction WHS Accreditation Scheme (the Scheme), which is administered by the Office
of the Federal Safety Commissioner (OFSC). It also contains template reporting forms which accredited contractors are
required to use, as well as detailed guidance on how these forms may be completed, and a completed example of each
form.
Scope
Under Regulation 14 of the Fair Work (Building Industry – Accreditation Scheme) Regulations 2005 (the Regulations), it
is a condition of accreditation that accredited contractors comply with the reporting requirements of the Scheme.
Accredited contractors are required to provide information to the OFSC on WHS performance. This is achieved by
completing and submitting the forms located in Section Four of this WHS Performance Reporting Pack. The OFSC
requires information from accredited contractors at different stages throughout the life of both Australian Government
and commercial building contracts on which they are the head contractor. Accredited contractors are also required to
submit Biannual Reports on their overall WHS performance, including information on projects not covered by the
Scheme. This WHS Performance Reporting Pack details the various reports required by the OFSC, including
information regarding when they are due, under what circumstances they need to be submitted, the purpose of this
data collection, and where to access help and guidance.
Why measure WHS performance?
Despite the efforts of WHS regulators, industry and workers, the incidence of death and injury on building and
construction industry worksites remains unacceptably high. The OFSC was established to address the relatively poor
WHS performance of the building and construction industry when compared with other industries. A priority for the
OFSC has been to establish the Scheme. The aim of the Scheme is to encourage cultural change in the building and
construction industry and lift WHS performance, not only on Australian Government building sites, but across all
Australian building sites. The Scheme Reporting Framework is designed to monitor the WHS performance of
accredited contractors, and collect data for the provision of guidance on how improvements in WHS performance may
be achieved and sustained.
Why is it important to collect this information?
The Federal Safety Commissioner (FSC) is aware of the overall reporting burden faced by businesses in their day-today activities. The Scheme Reporting Framework was developed by the OFSC in consultation with both industry and
Australian Government representatives, in an effort to develop a framework which balances the compliance
requirements of accredited contractors with the requirements of the Scheme and the OFSC in general.
The information collected enables the OFSC to carry out a number of important objectives, including:
1.
Assessing the ongoing suitability of accredited contractors to remain accredited under the Scheme. This is
vital to maintaining the integrity of the Scheme and recognising the efforts of those accredited contractors who
are continuing to maintain a satisfactory WHS performance;
2.
Analysing WHS trends relating to accredited contractors, cultural change in WHS practices and performance
relative to the building and construction industry as a whole. Theses analyses will allow the OFSC to make
well informed decisions regarding the direction of the Scheme and the focus of routine safety audits;
3.
Developing benchmarks and guidance material based on the information and trends analysed, which the
OFSC will be able to share with both accredited contractors and the building and construction industry in
general.
The aim is not only to share information on practices that can be improved in the industry, but also to highlight what is
already being done well.
Completion and submission of the WHS performance reports to the OFSC is a requirement under the Scheme. These
WHS performance reports will enable the OFSC to produce benchmarks, trends, guidance and educational material
based on the actual needs of accredited contractors and the greater building and construction industry.
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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What happens to the information I provide?
The OFSC may use the information in the WHS performance reporting forms for the following purposes:
a)
To monitor the WHS performance of accredited contractors;
b)
To assist a Commonwealth agency or authority to assess the suitability of accredited contractors when
entering into Commonwealth building contracts; and
c)
To enable the analysis of trends in each accredited contractor’s WHS performance.
All information provided to the OFSC is strictly confidential and will be treated as Commercial-in-Confidence. However,
in administering the Scheme the FSC may disclose some of the information collected to other Australian Government
agencies, and Commonwealth, State or Territory authorities. The FSC may also disclose the information if it is in the
public interest that the information be disclosed.
Any such disclosure would be undertaken in accordance with the Fair Work (Building Industry) Act 2012 and the
Building and Construction Industry Improvement Regulations 2005.
Submission, help and advice
All WHS performance reporting forms should be completed with reference to the definitions in Section Two as well as
the guides for completing the forms in Section Four of this WHS Performance Reporting Pack, and returned to the
OFSC by the prescribed deadlines. Forms can be submitted either by mail, email or fax via the details below.
Email:
FSCreporting@employment.gov.au
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
Website:
www.fsc.gov.au
Further advice and assistance regarding accredited contractor reporting obligations under the Scheme is available by
calling the OFSC Assist Line on 1800 652 500.
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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Overview of the Reporting framework
Requirement
When
Details
Contract Declaration Form
As soon as agreement is reached on
a tender, or a contract is signed for a
Scheme project

Notifies the OFSC of the details
regarding a new Scheme project
that was awarded to the
accredited contractor
Scheme Project Report


Incidents, hours worked and
notices on a Scheme project

Whether any high risk
construction has taken place on
the project
Following:

Location / incident details


Breakdown agency of incident

Working days /shifts lost and/or
significant change to duties
made/expected

Injured party details, project
details, work activity details

Investigation details (if reporting
a fatality)

OFSC Incident Report

Biannual Activity Report
Report 6 monthly, due on 15
October and 15 April each year
and at the completion of a
Scheme project (within 2 weeks
of the project completion date)
A separate report must be
submitted for each Scheme
project
All fatalities irrespective of the
project value or type (notify
immediately to 1800 652 500 and
provide report within 48 hours);
Any incident on a Scheme or
non-Scheme project resulting in a
LTI (reporting of AWIs is also
encouraged ) where the project
value is $3 million or more
(provide report within 48 hours if
a Notifiable Incident, otherwise
provide report within 3 weeks);

Any MTI or dangerous
occurrence on a Scheme project
(provide report within 48 hours if
a Notifiable Incident, otherwise
provide report within 3 weeks)

Report 6 monthly, due on 15
February and 15 July each year

Fatalities


Numbers of LTIs and MTIs
All accredited contractors must
submit, even if no projects
(Scheme and/or non-Scheme)
have been undertaken in the
period

Injury and incident number and
profile

Current workers’ compensation
premium rate

Notices, prosecutions

PPI, key initiatives
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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Section Two
Definitions
This section provides information and descriptions of general terms as defined by the OFSC.
Further information on how to complete each of the OFSC Reporting requirements can be found in the detailed guides
accompanying each report in Section Four on page 8 of this WHS Performance Reporting Pack.
Australian Government
Definition:
The Commonwealth Government; the Federal Government. Does not include State or
Territory governments.
Building work
Building work for OFSC purposes includes:

Buildings, structures or works that form, or are to form, part of land

Railways and docks

Fit outs

Preparatory/finishing operations (ie fencing, surveying)

On-site prefabrication

Residential projects involving attached or semidetached dwellings (such as duplexes, townhouses,
apartments, terrace houses, aged care units etc).
Building work for OFSC purposes does not include:

Work for obtaining oil, natural gas or minerals

Off-site prefabrication

Projects involving the construction, alteration, extension or refurbishment of single dwelling houses (a singledwelling house means a building that comprises one stand-alone (detached) residential dwelling for a single
household).
Building and construction covered by the Scheme can then be divided into the three following types:
Residential building – attached or semidetached houses and residential complexes (flats, home units, town houses,
villas, terrace houses, semi detached, duplexes, apartments, aged care facilities etc) but excluding medium and high
density apartments (3 or more storeys).
Commercial building – offices, shops, hotels, other business premises, industrial, social and institutional, plus
medium and high density apartments (3 or more storeys).
Civil or engineering construction – roads and bridges, railways, ports, water storage and supply, sewerage,
telecommunications, pipelines, drainage, earthworks, heavy industry-related (refineries, pumping stations, mines,
chemical plants, furnaces, steel mills, etc).
Non-Scheme Project
Definition:
A project which does not meet the Scheme thresholds. Any contract for building work
under a non-Scheme project is not required to be carried out by an accredited contractor.
Guide for use:
See “Scheme Project” for a definition of a project which meets the Scheme thresholds.
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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Scheme Project
Definition:
A project that is directly or indirectly funded by the Australian Government which meets the
Scheme thresholds. Any contract for building work under a Scheme project must be
carried out by an accredited contractor.
Guide for use:
Projects directly funded by the Australian Government
Projects are considered to be directly funded when the Australian Government has responsibility for the project funding
and development.
The Scheme applies to projects that are directly funded where the value of the building contract is $4 million or more
(GST inclusive).
Some typical examples of directly funded projects are: a new Medicare office, a Defence facility or the refurbishment of
Australian Government office accommodation.
Projects indirectly funded by the Australian Government:
Projects are considered to be indirectly funded when the Australian Government contributes funding to a third party
recipient, for example a state government, through mechanisms such as funding agreements, grants, or other
programs.
The Scheme applies to projects that are indirectly funded by the Australian Government where:

the value of the Australian Government contribution to the project is at least $6 million (inc. GST) and
represents at least 50 per cent of the total construction project value; or

the Australian Government contribution to a project is $10 million (inc. GST) or more, irrespective of the
proportion of Australian Government funding.
If a project meets the above requirements, where any ‘head contracts’ for building work are awarded that have a value
of $4 million or more (inc. GST), the Scheme will apply and an accredited builder must be appointed.
Some typical examples of indirect funding are where the Australian Government provides funding to a state or territory
government to build a new school, a hospital or roads.
Preconstruction agreements, such as pre-commitment leases, public private partnerships (PPPs), build-own-operate
(BOO) and build-own-operate-transfer (BOOT) agreements fall within the scope of the Scheme.
Please contact the OFSC if you are unsure if your project should be treated as a Scheme project.
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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Section Three
Frequently asked questions
What projects do I need to report on?
Accredited contractors will need to submit a contract declaration form as well as a Scheme Project Report every six
months for every Scheme project that they currently have.
In addition, accredited contractors will need to submit Incident Reports for:

All fatalities on both Scheme and non-Scheme projects, irrespective of the project value (notify immediately to
1800 652 500 and provide report within 48 hours);

Any incident resulting in a LTI on Scheme and non-Scheme projects (the OFSC also encourages the reporting
of AWIs [Alternate Work Injuries]) where the project value is $3 million or more (provide report within 48 hours
if a Notifiable Incident, otherwise provide report within 3 weeks); and

Any MTI (may include AWI’s if that is your company’s internal reporting practice) or dangerous occurrence on
a Scheme project (provide report within 48 hours if a notifiable incident, otherwise provide report within 3
weeks).
Accredited contractors will also need to submit a Biannual Activity Report for the January-June and July-December
reporting periods each year. These reports cover both Scheme and non-Scheme projects that are carried out by the
accredited contractor during these periods.
If you are unsure of whether you need to report on a particular project or for a particular type of incident, please contact
the OFSC.
I currently have a maintenance contract with a number of projects under it. Does this count as one
project, or do I include the number of projects as well?
Accredited contractors are required to report on the number of head contracts for Scheme projects that they are
carrying out. The head contract may comprise a number of sub-projects which should not be included in calculating
the number of contracts. Similarly, in submitting reports for Scheme projects, accredited contractors should submit only
one report for each contract even if there are a number of sub-projects under that contract. This means, for example,
that the Scheme Project Report should include the aggregate figures for all projects under the contract.
A number of our subsidiaries and affiliated companies are also accredited under the Scheme. Do
we just submit one report for all companies?
Every accredited contractor must submit its own reports. This means that if subsidiaries and affiliated companies are
accredited independently of each other, each company must submit its own reports.
Where a number of entities or companies have been granted joint accreditation under the Scheme, only one set of
reports needs to be provided for the accredited entity as a whole.
We did not undertake any Scheme projects in the six month Biannual reporting period. Are we still
required to submit reports?
Accredited contractors are still required to submit Incident Reports for all projects as outlined in the first question on this
page. Accredited contractors are also required to submit Biannual Activity Reports even if they did not undertake any
Scheme projects in the six month Biannual reporting period.
Can we provide copies of the submitted OFSC reports to our clients and other persons?
Accredited contractors can share information they have provided to the OFSC with any other person, entity or
organisation. However, any information provided to the OFSC is treated confidentially by the OFSC and can only be
disclosed in the circumstances set out in the Fair Work (Building Industry) Act 2012 and the Building and Construction
Industry Improvement Regulations 2005.
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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We have signed a new contract but we are not sure if it falls within the Scheme or has
Commonwealth Government funding. How do we find out if we are required to submit reports for
this project?
The tender and contract documents should indicate whether this is a Scheme project and if so, who is required to be
accredited. If accredited contractors require further confirmation, at first instance they should ask the entity that
awarded the contract if the project falls within the Scheme thresholds. Refer to the definition of Scheme project in
Section Two on page 4 of this WHS Performance Reporting Pack for further information regarding the Scheme
thresholds. Should the entity that awarded the contract not be able to provide this information, accredited contractors
can contact the OFSC via the details below for further assistance.
It is my responsibility to complete the OFSC reporting for the accredited international company I
am employed by. Do I report on all the building and construction projects we work on, or just those
in Australia?
The OFSC only requires international companies that are accredited to report on the building and construction work
they perform within Australia, this includes any incidents such as fatalities.
I’m unsure what information a particular section of a report is asking for, where can I seek guidance
on definitions or calculations?
General definitions can be found in Section Two on pages 4 and 5 of this WHS Performance Reporting Pack. In
addition, Section Four beginning on page 8 contains a detailed step-by-step guide to assist in completing each of the
OFSC reports. These guides provide an explanation of the information required for each section of the reports. A
completed example of each of the reports is also included in Section Four. If you require further assistance in
completing your OFSC reports, please contact the OFSC via the details below.
Telephone:
1800 652 500
Email:
FSCreporting@employment.gov.au
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
7
Section Four
WHS performance reports
This section contains the WHS performance reporting forms that accredited contractors are required to complete to
fulfil their reporting requirements under the Scheme along with detailed guides for each of the reports. Within each of
the guides there are also examples of the information the OFSC is seeking in each report. In completing the forms
please also refer to the definitions and information in Sections One and Two of this WHS Performance Reporting Pack.
Example reports
Following each of the guides and reports in this section is a completed sample of each report. The samples are
completed for the fictitious accredited contractor Safety First Building Company Pty Ltd and demonstrate how the forms
should be completed. All figures provided in the forms are for indicative purposes and may not necessarily reflect
actual calculations.
The example forms assume that Safety First Building Company Pty Ltd (Safety First) is an accredited contractor under
the Scheme. Between 1 January 2011 and 31 December 2011, they had the following contracts:
Contract
Value
Type
Direct
Subcontractors
End date
employees
A
$35M
Head contract: Scheme
15
150
September 2018
B
$2M
Head contract: non-Scheme
5
15
February 2017
C
$5M
Head contract: Scheme
5
40
March 2016
D
$15M
Head contract: non-Scheme
10
125
October 2016
E
$50M
Subcontract: under another
contractor who is the
accredited contractor
20
300
April 2017
55
630
TOTAL
Office of the Federal Safety Commissioner - WHS Reporting Pack - January 2015
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Guide for completing the OFSC Contract Declaration Form
Accredited contractors are required to submit a Contract Declaration Form to the OFSC as soon as agreement is
reached on a tender, or as soon as a contract is signed, for a project that falls within the scope of the Scheme (see
page 4 of this WHS Performance Reporting Pack for guidance on Scheme projects). Contract Declaration Forms need
to be submitted for all Scheme projects.
The purpose of the Contract Declaration Form is to notify the OFSC of Scheme projects so that reporting requirements
can be established and communication with all parties can commence regarding requirements under the Scheme.
Below is detailed guidance on how to complete your Contract Declaration Form. A copy of the form and an
example of a completed form follows this guide.
Part A – Contract information
All fields in part A must be completed
A1 Accredited contractor
Provide the name of the accredited contractor who is the head contractor for the contract.
A2 Accreditation number
Provide the accreditation number the OFSC has allocated to the accredited company. This is used to validate question
A1. If you are unsure of your accreditation number please contact the OFSC for further information.
A3 Contact person for OFSC reporting
Provide the name of the person to contact regarding OFSC reporting for this project.
A4 Position
The nominated reporting contact person’s job title. Please also specify the name of the company that employs this
person if different to the accredited contractor.
A5 Telephone
Provide the most convenient and available contact number for the nominated reporting contact person.
A6 Email
Provide the email address for the nominated reporting contact person.
A7 Contact person for OFSC Audits
Provide the name of the person to contact regarding OFSC auditing if this person is different from the reporting contact
person for this project.
A8 Position
Provide the nominated audit contact person’s job position title. Please also specify the name of the company that
employs this person if it is different to the accredited contractor.
A9 Telephone
Provide the most convenient and available contact number for the nominated audit contact person.
A10 Email
Provide the email address for the nominated audit contact person.
A11 Project name
Provide the project name as it was stated on the contract signed with the client. Please provide the whole project title
with no acronyms.
A12 Who was this contract signed with (ie the agency or client)?
Provide the name of the agency/ or client that the contract was signed with. For example, this may be a State or
Federal Government department, University or private sector body.
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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A13 Contact person at above agency
Provide the name of the person at the above agency the OFSC can contact regarding the project.
A14 Position
Provide the position title of the agency contact person.
A15 Telephone
Provide the most convenient and available contact number for the nominated agency contact person.
A16 Email
Provide the email address for the nominated agency contact person.
A17 Which Commonwealth agency is providing the funding (if known)?
Provide the name of the Federal Government department or agency that provided the funding for this project, if known.
A18 Amount of Commonwealth funding
Provide the amount of Commonwealth funding awarded to your company for this project.
A19 Contract value (inclusive of GST)
Provide the total value of the whole project. This includes the total amount of Commonwealth funding awarded to you
and other contractors, as well as funding from other sources.
A20 Date contract signed
Provide the date that the contract was signed.
A21 Date building work commences
Provide the date that the building work commenced on this project. If the building work has yet to commence, please
provide an estimated start date.
A22 Contract end date
Provide the end date for the contract. If an exact date is not known, please provide an estimated end date. If this date
changes throughout the life of the project, please inform the OFSC so that the project records can be updated.
A23 Address of site(s)
Provide the street address of the site(s) for the project. Please include the town/suburb, State and postcode. Where
there are multiple sites, please specify the addresses for all sites. Where an exact street address is not available,
please provide details of the site locality (ie nearest main road).
A24 Construction type
Residential building – attached or semidetached houses and residential complexes (flats, home units, town houses,
villas, terrace houses, semi detached, duplexes, apartments, aged care facilities etc) but excluding medium and high
density apartments (3 or more storeys).
Commercial building – offices, shops, hotels, other business premises, industrial, social and institutional, plus
medium and high density apartments (3 or more storeys).
Civil or engineering construction – roads and bridges, railways, ports, water storage and supply, sewerage,
telecommunications, pipelines, drainage, earthworks, heavy industry-related (refineries, pumping stations, mines,
chemical plants, furnaces, steel mills, etc).
A25 Project description/type of work being undertaken (eg number and type of dwellings, stadium
construction, road works etc)
Provide a description of the project including the type of work being undertaken. For example:
-
Design and construct 15 single dwelling houses.
Extend and widen pavement and shoulder and improve intersections along 10 kilometre section of XYZ Road.
Extension to existing building, fit out and refurbishment of existing 3 floors.
Demolition and excavation of site, construction of 8 storey building with underground and ground level car
park.
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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A26 Is this a Joint Venture or Alliance Project? If so, please name all other joint venture or alliance members
that are undertaking building work
Provide the names of all other joint venture or alliance members that are undertaking building work. All companies
undertaking building work must be accredited under the Scheme. Only one company is required to submit the contract
declaration form. The OFSC will be in contact to discuss the reporting and auditing arrangements for the duration of the
project.
A27 If your accreditation is comprised of more than one company (joint accreditation) please identify which of
these companies will be undertaking building work on the project:
For the purposes of audit scheduling the OFSC needs to know which company within the joint accreditation is
undertaking the building work on the project.
Part B – Tick each high risk construction work hazard applicable to work being carried on this project
High risk categories
If applicable, tick the corresponding box if any of the work performed on this project falls within any of the 19 high risk
construction categories listed below.
1. Where there is a risk of a person falling two metres or more
2. On telecommunications towers
3. Involving demolition
4. Involving the disturbance or removal of asbestos
5. Involving structural alterations that require temporary support to prevent collapse
6. Involving a confined space
7. Involving excavation to a depth greater than 1.5 metres
8. The construction of tunnels
9. Involving the use of explosives
10. On or near pressurised gas distribution mains and consumer piping
11. On or near chemical, fuel or refrigerant lines
12. On or near energised electrical installations and services
13. In an area that may have a contaminated or flammable atmosphere
14. Tilt-up and precast concrete construction work
15. On or adjacent to roadways or railways used by road or rail traffic
16. Involving powered mobile plant
17. In an area where there are artificial extremes of temperature
18. In, over or adjacent to water or other liquids where there is a risk of drowning
19. Involving diving.
Part C – Details of person completing this form
C1 Name
The name of the person completing the contract declaration form.
C2 Position
The job title of the person completing the contract declaration form.
C3 Date
The date that the contract declaration form was completed.
C4 Additional comments
Any additional comments relating to the company, project or the contract declaration being submitted.
Please email, fax or post your completed Contract Declaration to:
Email:
FSCreporting@employment.gov.au
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
11
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
Website:
www.fsc.gov.au
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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OFSC Contract Declaration Form
Accredited contractors are required to submit a Contract Declaration form to the OFSC as soon as agreement is
reached on a tender, or as soon as a contract is signed, for a project that falls within the scope of the Scheme.
PART A - Contract Information–ALL FIELDS MUST BE COMPLETED
A1 Accredited contractor:
A2 Accreditation number:
A3 Contact person for OFSC Reporting:
A4 Position:
A5 Telephone:
A6 Email:
A7 Contact Person for OFSC Audits:
A8 Position:
A9 Telephone:
A10 Email:
A11 Project name:
A12 Who was this contract signed with (ie the agency or client)?
A13 Contact person:
A14 Position:
A15 Telephone:
A16 Email:
A17 Which Commonwealth agency is providing the funding (if known)?
A18 Amount of Commonwealth funding:
A19 Contract value (inclusive of GST):
A20 Date contract signed:
A21 Date building work commences:
A22 Contract end date:
A23 Address of site(s):
A24. Construction type:
Commercial
Civil
Residential
A25 Project description (eg number and type of dwellings, stadium construction, road works etc):
A26 Is this a Joint Venture or Alliance Project? If so, please name all other joint venture or alliance members
that are undertaking building work :
A27: If your accreditation is comprised of more than one company (joint accreditation) please identify which
of these companies will be undertaking building work on the project:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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Part B - Tick each high risk construction work hazard applicable to work being carried out on this project
1.
Construction work with risk of a person falling
two metres or more
11. Construction work on or near chemical, fuel
or refrigerant lines
2.
Construction work on telecommunications
towers
12. Construction work on or near energised
electrical installations and services
3.
Construction work involving demolition
13. Construction work in an area that may have
a contaminated or flammable atmosphere
4.
Construction work involving the disturbance or
removal of asbestos
14. Tilt-up and precast concrete work
5.
Construction work involving structural alterations
that require temporary support to prevent
collapse
15. Construction work on or adjacent to
roadways or railways used by road or rail
traffic
6.
Construction work involving a confined space
16. Construction work on construction-sites
where there is any movement of powered
mobile plant
7.
Construction work involving excavation to a
depth greater than 1.5 m
17. Construction work in an area where there
are artificial extremes of temperature
8.
The construction of tunnels
18. Construction work in, over or adjacent to
water or other liquids where there is a risk of
drowning
9.
Construction work involving the use of
explosives
19. Construction work involving diving
10. Construction work on or near pressurised gas
distribution mains and consumer piping
[This section for OFSC use only] Contract Number:
Part C – Details of person completing this form
C1 Name:
C2 Position:
C3 Date:
C4 Additional comment:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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Sample OFSC Contract Declaration Form
Contract A is a new $35 million project. Safety First Building Company Pty Ltd was awarded the head contract, which
was signed on 1 December 2012 with the State Department of Roads for the Australian Highway with an end date of 1
September 2015. Construction is to commence on 1 January 2013. The State Department of Roads required them to
be accredited, because the Commonwealth Government (through the Commonwealth Department of Infrastructure and
Highways) contributed $15 million funding. Safety First Building Company Pty Ltd submits a Contract Declaration Form
for this new contract.
PART A - Contract Information–ALL FIELDS MUST BE COMPLETED
A1 Accredited contractor: Safety First Building Company
A2 Accreditation number: 12345
A3 Contact person for OFSC Reporting: John Smith
A4 Position: WHS Manager
A5 Telephone: 01 8888 6666
A6 Email: jsmith@safetyfirstbcpl.com.au
A7 Contact Person for OFSC Audits: Bob Thomas
A8 Position: Site Manager
A9 Telephone: 01 8888 5555
A10 Email: bthomas@safetyfirstbcpl.com.au
A11 Project name: Australian Freeway
A12 Who was this contract signed with (ie the agency or client)? State Department of Roads
A13 Contact person: Sue Black
A14 Position: Director of Property
A15 Telephone: 01 8888 7777
A16 Email: s.black@state.roads.gov.au
A17 Which Commonwealth agency is providing the funding (if known)? Department of Infrastructure and
Highways
A18 Amount of Commonwealth funding: $15 million
A19 Contract value (inclusive of GST): $35 million
A20 Date contract signed: 1 December 2014
A21 Date building work commences: 1 January 2015
A22 Contract end date: 1 September 2018
A23 Address of site(s): Australian Freeway, Canberra ACT
A24. Construction type:
Commercial
Civil
Residential
A25 Project description/type of work being undertaken (eg number and type of dwellings, stadium
construction, road works etc):: Widening of 5km section of Australian Freeway including bridge work
A26 Is this a Joint Venture or Alliance Project? If so, please name all other joint venture or alliance members
that are undertaking building work : No
A27: If your accreditation is comprised of more than one company (joint accreditation) please identify which
of these companies will be undertaking building work on the project: Safety First ACT Pty Ltd
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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Part B - Tick each high risk construction work hazard applicable to work being carried out on this project
1.
Construction work with risk of a person falling
two metres or more
11. Construction work on or near chemical, fuel
or refrigerant lines
2.
Construction work on telecommunications
towers
12. Construction work on or near energised
electrical installations and services
3.
Construction work involving demolition
13. Construction work in an area that may have
a contaminated or flammable atmosphere
4.
Construction work involving the disturbance or
removal of asbestos
14. Tilt-up and precast concrete work
5.
Construction work involving structural alterations
that require temporary support to prevent
collapse
15. Construction work on or adjacent to
roadways or railways used by road or rail
traffic
6.
Construction work involving a confined space
16. Construction work on construction-sites
where there is any movement of powered
mobile plant
7.
Construction work involving excavation to a
depth greater than 1.5 m
17. Construction work in an area where there
are artificial extremes of temperature
8.
The construction of tunnels
18. Construction work in, over or adjacent to
water or other liquids where there is a risk of
drowning
9.
Construction work involving the use of
explosives
19. Construction work involving diving
10. Construction work on or near pressurised gas
distribution mains and consumer piping
[This section for OFSC use only] Contract Number:
Part C – Details of person completing this form
C1 Name: John Smith
C2 Position: WHS Manager
C3 Date: 1 December 2014
C4 Additional comment:
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Guide for completing the Scheme Project Report
This form should be submitted by all accredited contractors that have a Scheme project (see the definitions in Section
Two of this WHS Performance Reporting Pack for further information on what defines a Scheme project) on the
following schedule:



April to September (or any part there-of) report by 15 October
October to March (or any part there-of) report by 15 April
At end of project submit within two weeks of the project end date. Include all data from the entire project from
start to finish.
Please complete all parts of the form and verify that all Incident Reports for the period have also been submitted to the
OFSC. An Incident Report form can be found on page 31 of this WHS Performance Reporting Pack. A separate
Scheme Project Report must be submitted for each Scheme project.
Below is detailed guidance on how to complete your Scheme Project Report. A copy of the form and an example of a
completed form follows this guide.
Part A – Project Information
Identifies the project, period reported and contact details should the OFSC require any clarification on the information
provided in the form.
A1 Accredited contractor
Provide the name of the accredited contractor who is the head contractor for the project.
A2 Accreditation number
Provide the accreditation number the OFSC has allocated to the accredited company. This is used to validate question
A1. If you are unsure of your accreditation number please contact the OFSC for further information.
A3 Project name
Provide the name of the Scheme project that is the subject of this report. This should match the name on the Contract
Declaration Form which was provided to the OFSC at the beginning of the project.
A4 Contract number
Provide the contract number allocated by the OFSC to this project. This is used to validate question A3. Please contact
the OFSC if you are unsure of the allocated contract number.
A5 Date project actually complete
Records the actual end date for the project. Only complete this section if you are submitting the report at the conclusion
of a project. In this case, the period reported at A10 should be the date the building work commenced to the date of
practical completion of the project. Data for the whole project should be provided for each of the questions.
A6 Contact person
Provide the name of the person to contact if the OFSC requires any clarification on the information provided in the
form.
A7 Position
Provide the position title of the nominated contact person. Please also specify the name of the company that employs
this person if different to the accredited contractor.
A8 Telephone
Provide the most convenient and available contact number for the nominated contact person.
A9 Email
Provide the email address of the nominated contact person.
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A10 Period covered
Indicate the period covered by this report. Normally this would cover the relevant 6 month period e.g. 10/2009 to
03/2010. Where the project ends during a period the start and end period would match the start and end month/year of
the project.
Part B - WHS Performance data for all building and civil construction work on the project in the period
Records outcome data for building and civil construction work in the reporting period.
B1 Number of incidents in the reporting period: Enter the number of each incident type that occurred on the project
during the reporting period (or during the whole project if you are completing an end of project report). Please count
each incident once only. Where an incident has resulted in medical treatment and lost time, the incident should be
counted as an LTI only. Please forward any outstanding incidents to the OFSC using the Incident Report form on page
31 of this WHS Performance Reporting pack.
This data is used to reconcile previously submitted incident reports that relate to the reporting period.
B2 Hours worked by all accredited contractor employees and subcontractors in the period
Enter the total number of hours worked in each construction category. For most projects only one category will be
used. Hours should only be split across multiple categories on projects where there are clearly separate work sites of
different types e.g. a project to build an airport would likely have a civil runway component and a commercial terminal
building component. Alternatively, a project involving construction of a car park or access road that is incidental to a
commercial building project would be reported as commercial only.
These figures will be used to calculate LTIFR and MTIFR figures for each construction category and for assessments
of project size for the period.
Part C - Notices issued for the project during the period
Records the outcomes of work cover assessments or court actions issued during the period. Provide the number and a
description for any notices issued in any of the four categories below.
When completing OFSC reports, the number of notices for the period (or the entire duration of the project if the report is
being prepared at the completion of the project) is to include all notices issued to both the accredited contractor as well
as those issued to any subcontractors working on site.
C1 Infringement
An infringement notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued
by the relevant WHS authority.
WHS regulations may allow for infringement notices to be issued as an alternative to prosecution for an offence that is
not indictable.
C2 Prohibition
A prohibition notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued by
the relevant WHS authority.
These notices are issued when a WHS inspector determines that there is a serious risk that needs urgent attention.
Prohibition notices are issued for any work that involves or will involve an immediate risk to the health, safety and
welfare of any person.
C3 Improvement
An improvement notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued
by the relevant WHS authority.
In the various jurisdictions, a WHS inspector may issue an improvement notice if they believe someone has
contravened the Act or regulations, or that a contravention may continue to be repeated. The notice will identify the
provisions of the Act or regulations that have been, or may be contravened, the reasons for the notice, and a deadline
for remedial action.
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An improvement notice may also include directions about how to remedy a breach. When completing OFSC reports,
the number of notices for the period is to include all notices issued to both the accredited contractor and any
subcontractors working on a site where the accredited contractor is the head contractor.
C4 Other – (e.g. enforceable undertakings)
A WHS related notice (other than an infringement, prohibition or improvement notice) issued by the relevant WHS
authority in the jurisdiction in which the project is being undertaken.
Part D - Indication of any high risk construction work on the project during the period as defined below
D1 High Risk Construction categories (if applicable): Record any high risk construction categories from the list of
19 below that applied to any work performed on this project in the period.
1. Where there is a risk of a person falling two metres or more
2. On telecommunications towers
3. Involving demolition
4. Involving the disturbance or removal of asbestos
5. Involving structural alterations that require temporary support to prevent collapse
6. Involving a confined space
7. Involving excavation to a depth greater than 1.5 metres
8. The construction of tunnels
9. Involving the use of explosives
10. On or near pressurised gas distribution mains and consumer piping
11. On or near chemical, fuel or refrigerant lines
12. On or near energised electrical installations and services
13. In an area that may have a contaminated or flammable atmosphere
14. Tilt-up and precast concrete construction work
15. On or adjacent to roadways or railways used by road or rail traffic
16. Involving powered mobile plant
17. In an area where there are artificial extremes of temperature
18. In, over or adjacent to water or other liquids where there is a risk of drowning
19. Involving diving.
This data is used to identify those high risk areas where no incidents occur and may show control strengths.
Part E – Details of the person completing the form
Used to identify the source and validity of the form.
E1 Name
The name of the person completing the incident report form.
E2 Position
The job title of the person completing the incident report form.
E3 Date
The date that the Scheme Project report form was completed.
E4 Additional comments
Any additional comments relating to the company, Scheme Project or data being submitted.
Please email, fax or post your completed form to:
Email:
FSCreporting@employment.gov.au
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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Scheme Project Report
This form should be submitted by all accredited contractors that have a Scheme project (see the definitions in Section
Two on page 4 of this WHS Performance Reporting pack for further information on what defines a Scheme project) on
the following schedule:



April to September (or any part thereof) report by 15 October
October to March (or any part thereof) report by 15 April
At end of project submit within two weeks of the project end date. Include data from the entire project from
start to finish.
Please complete all parts of the form and verify that all Incident Reports for the period have also been submitted to the
OFSC.
Part A - Project information
A1 Accredited contractor:
A2 Accreditation number:
A3 Project name:
A4 Contract number (allocated by the OFSC):
A5 Date project actually completed (End-of-Project only):
A6 Contact person:
A7 Position:
A8 Telephone:
A9 Email:
A10 Period covered (Enter full project period if end of project):
From:
To:
Part B - WHS performance data for all building and civil construction work on the project in the period
Dangerous
occurrences
WHS incident numbers
MTI’s
LTI’s
Fatalities
B1 Number of incidents in the reporting
period:
Commercial
Total hours worked on this project
Civil
Residential
B2 Hours worked by all accredited contractor employees
and subcontractors in the period:
Part C - Notices issued for the project during the period
WHS Performance data
Number
Comments/Description
C1 Infringement:
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WHS Performance data
Number
Comments/Description
C2 Prohibition:
C3 Improvement:
C4 Other – (e.g. enforceable
undertakings):
Part D - Indication of any high risk construction work on the project during the period as defined below
D1 High Risk Construction Categories (if applicable)
1.
Construction work with risk of a person falling
two metres or more
11. Construction work on or near chemical, fuel
or refrigerant lines
2.
Construction work on telecommunications
towers
12. Construction work on or near energised
electrical installations and services
3.
Construction work involving demolition
13. Construction work in an area that may have
a contaminated or flammable atmosphere
4.
Construction work involving the disturbance or
removal of asbestos
14. Tilt-up and precast concrete work
5.
Construction work involving structural alterations
that require temporary support to prevent
collapse
15. Construction work on or adjacent to
roadways or railways used by road or rail
traffic
6.
Construction work involving a confined space
16. Construction work on construction-sites
where there is any movement of powered
mobile plant
7.
Construction work involving excavation to a
depth greater than 1.5 m
17. Construction work in an area where there
are artificial extremes of temperature
8.
The construction of tunnels
18. Construction work in, over or adjacent to
water or other liquids where there is a risk of
drowning
9.
Construction work involving the use of
explosives
19. Construction work involving diving
10. Construction work on or near pressurised gas
distribution mains and consumer piping
Part E – Details of person completing this form
E1 Name:
E2 Position:
E3 Date:
E4 Additional comments:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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Sample Scheme Project Report
On 15 April 2012, Safety First Building Company Pty Ltd submits the Scheme Project Report for contract C, which is
the Australian Highway project. In the 6 month period the report covers, they have had 2 dangerous occurrences, 7
MTIs and 1 LTI occur on site. The company submitted incident reports to the OFSC as required for these incidents.
Part A - Project information
A1 Accredited contractor: Safety First Building Company Pty Ltd
A2 Accreditation number: 12345
A3 Project name: Australian Highway
A4 Contract number (allocated by the OFSC): 3333
A5 Date project actually completed (End-of-Project only): N/A project ongoing
A6 Contact person: John Smith
A7 Position: WHS Manager
A8 Telephone: 01 8888 6666
A9 Email: jsmith@safetyfirstbcpl.com.au
A10 Period covered (Enter full project period if end of project):
From: 10/2015
To: 03/2016
Part B - WHS performance data for all building and civil construction work on the project in the period
WHS incident numbers
B1 Number of incidents in the reporting
period:
Dangerous
occurrences
MTI’s
LTI’s
Fatalities
2
7
1
0
Total hours worked on this project
Commercial
Civil
Residential
B2 Hours worked by all accredited contractor employees
and subcontractors in the period:
0
40,000
0
Part C - Notices issued for the project during the period
WHS Performance data
Number
Comments/Description
C1 Infringement:
0
C2 Prohibition:
0
C3 Improvement:
1
Generation of dust by mobile plant – still to be rectified. New processes
being drafted, will be implemented in next 2 months.
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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WHS Performance data
Number
C4 Other – (e.g. enforceable
undertakings):
0
Comments/Description
Part D - Indication of any high risk construction work on the project during the period as defined below
D1 High Risk Construction Categories (if applicable)
1.
Construction work with risk of a person falling
two metres or more
11. Construction work on or near chemical, fuel
or refrigerant lines
2.
Construction work on telecommunications
towers
12. Construction work on or near energised
electrical installations and services
3.
Construction work involving demolition
13. Construction work in an area that may have
a contaminated or flammable atmosphere
4.
Construction work involving the disturbance or
removal of asbestos
14. Tilt-up and precast concrete work
5.
Construction work involving structural alterations
that require temporary support to prevent
collapse
15. Construction work on or adjacent to
roadways or railways used by road or rail
traffic
6.
Construction work involving a confined space
16. Construction work on construction-sites
where there is any movement of powered
mobile plant
7.
Construction work involving excavation to a
depth greater than 1.5 m
17. Construction work in an area where there
are artificial extremes of temperature
8.
The construction of tunnels
18. Construction work in, over or adjacent to
water or other liquids where there is a risk of
drowning
9.
Construction work involving the use of
explosives
19. Construction work involving diving
10. Construction work on or near pressurised gas
distribution mains and consumer piping
Part E – Details of person completing this form
E1 Name: John Smith
E2 Position: WHS Manager
E3 Date:15 April 2015
E4 Additional comments:
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Guide for completing the OFSC Incident Report
OFSC incident reporting requires companies to provide unit data records for each incident that occurs on site. This
report should be completed for the following incident types where they occur on building or civil construction sites and
the accredited contractor is the head contractor (all subcontractor incidents should be included):



All fatalities on both Scheme and non-Scheme projects, irrespective of the project value (notify immediately to
1800 652 500 and provide report within 48 hours);
Any incident resulting in a LTI on Scheme and non-Scheme projects (the OFSC also encourages the reporting
of AWIs [Alternate Work Injuries]) where the project value is $3 million or more (provide report within 48 hours
if a Notifiable Incident, otherwise provide report within 3 weeks); and
Any MTI (may include AWI’s if that is your company’s internal reporting practice) or dangerous occurrence on
a Scheme project (provide report within 48 hours if a notifiable incident, otherwise provide report within 3
weeks).
See Section Two on page 4 of this WHS Performance Reporting Pack for guidance on what is considered a Scheme
project.
Below is detailed guidance on how to complete your Incident Report form. A copy of the form and an example
of a completed form follows this guide.
Part A – Project details
Identifies the project and contact details should the OFSC require any clarification on the information provided in the
form.
A1 Accredited contractor
Provide the name of the accredited contractor who is the head contractor for the project where the incident occurred.
A2 Accreditation number
Provide the accreditation number the OFSC has allocated to the accredited contractor. This is used to validate question
A1. If you are unsure of your accreditation number please contact the OFSC.
A3 Contact person
Provide the name of the person to contact if the OFSC requires any clarification on the information provided in the
form.
A4 Position
Provide the nominated contact person’s job title. Please also specify the name of the company that employs this
person if different to the accredited contractor.
A5 Telephone
Provide the most convenient and available contact number for the nominated contact person.
A6 Email
Provide the email address for the nominated contact person.
A7 Construction type
Select the type of construction for the project. Only one type should be selected, so where a project involves more than
one type, please select the type for the largest portion of the project that is managed by the accredited company.
For OFSC purposes, construction types can be split between the following three categories:
Residential building – attached , detached or semidetached houses and residential complexes (flats, home units, town
houses, villas, terrace houses, semidetached, duplexes, apartments, aged care facilities etc) but excluding medium
and high density apartments (3 or more storeys).
Commercial building – offices, shops, hotels, other business premises, industrial, social and institutional, plus medium
and high density apartments (3 or more storeys).
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Civil or engineering construction – roads and bridges, railways, ports, water storage and supply, sewerage,
telecommunications, pipelines, drainage, earthworks, heavy industry-related (refineries, pumping stations, mines,
chemical plants, furnaces, steel mills, etc).
A8 Project name
Provide the full name of the project. For Scheme projects this should match the name that was provided on the
Contract Declaration previously submitted to the OFSC. Please give the full project name. Avoid using acronyms or
abbreviations (particularly for non-Scheme projects) so that consistent records can be maintained by the OFSC across
the life of a project.
Contract number
For OFSC Scheme projects, provide the contract number that has been allocated to the project by the OFSC. If you do
not have the contract number, contact the OFSC for further information. For non-Scheme projects please leave blank.
A9 Project Value
Select the project value range which reflects the total value of building and civil construction work on this project.
Part B - Incident details
B1 Date of incident
The date that the incident occurred.
B2 Time of incident
The time of the incident in 24 hour time.
B3 Project site location / address where incident occurred
Provide the location or full street address of the project. Please ensure you provide the town/suburb, State and
postcode.
B4 Incident type
Select the incident type from the four below. Please only select ONE incident type.
Dangerous occurrence - An incident where no person is injured, but could have been injured, resulting in Serious
Personal Injury (which requires a week or more away from work), Incapacity or Death. Also
commonly called a “near miss”. Only dangerous occurrences that are required to be reported under the
WHS legislation covering notifiable incidents in the jurisdiction the project is being undertaken are
required to be reported to the OFSC (see B5 below).
MTI (Medically treated injury) - A work-related occurrence that results in treatment by, or under the order of, a qualified
medical practitioner (see below), or any injury that could be considered as being one that would normally be treated by
a medical practitioner but does not result in the loss of a full day/shift. This may include AWI’s if that is your company’s
internal reporting practice. Do not report first aid treated injuries in this category.
An injury includes physical injuries as well as instances such as where a worker experiences psychological stress due
to witnessing a traumatic event or being a victim of bullying, or if they required medical attention due to migraines
caused by exposure to chemicals or gas. Please see section C6 and C8 below for further detail on the types of injuries
that are to be reported.
A qualified medical practitioner is defined as a person with a medical degree. The following would normally be
considered medical treatment:







Treatment of partial or full thickness burns
Insertion of sutures
Removal of foreign bodies embedded in eye
Removal of foreign bodies from a wound if the procedure is complicated by the depth of embedment, size or
location
Surgical debridement
Admission to a hospital or equivalent for treatment or observation
Application of antiseptics during second or subsequent visits to medical personnel
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



Any work injury that results in a loss of consciousness
Treatment of infection
Use of prescription medications (except a single one-off dose administered on the first visit for minor injury or
discomfort)
Treatment (diagnosis and evaluation) by a Psychiatrist for mental illness or stress as a result of a workplace
occurrence.
The following on their own would not normally be considered medical treatment:




Administration of tetanus shots or boosters
Physiotherapy
Diagnostic procedures such as X-rays or laboratory analysis, unless they lead to further treatment
Referral to/treatment by a Psychiatrist where the diagnosis is not a result of a workplace occurrence.
LTI (Lost time injury) - A work-related occurrence that results in a permanent disability or injury resulting in time lost
from work of one day/shift or more. Permanent disability is as defined in the legislation of the jurisdiction in which the
project is being undertaken.
An injury includes physical injuries (i.e cuts, burns, fractures etc) as well as instances such as where a worker
experiences psychological stress due to witnessing a traumatic event or being a victim of bullying (and may require
time off work as a result), or or if they required medical attention due to migraines caused by exposure to chemicals or
gas. Please see section C6 and C8 below for further detail on the types of injuries that are to be reported.
The OFSC strongly encourages accredited contractors to report Alternate Work Injuries (AWIs), however the reporting
of these injuries is optional. The definition of an AWI for OFSC purposes includes incidents where the injured worker
has a gradual return to their normal duties (ie works less than their normal hours), or returns to work to perform a
different role. For example, a worker returns to work to perform administration duties where the usual duties involve
intensive labour or operation of mobile plant. This may also include workers sent to unscheduled training due to their
incapacity to perform normal duties.
Fatality - A work-related occurrence that results directly or indirectly in the death of a person (including deaths due to
natural causes which occur on the project site).
B5 Is this a notifiable incident?
Select either yes or no.
A notifiable incident is one resulting in the death of a person, a serious injury or illness of a person, or a near miss
event/dangerous occurrence, that is required to be notified under the WHS legislation covering notifiable incidents in
the jurisdiction in which the project is being undertaken. Reports for notifiable incidents should be provided to the
OFSC within 48 hours.
B6 Break down agency of incident
From the list of nine below select the main event that initiated the incident.
The breakdown agency of incident is intended to identify the object, substance or circumstance that was principally
involved in, or most closely associated with, the point at which things started to go wrong and which ultimately led to
the most serious injury or disease.
1. Machinery and fixed plant includes: Cutting, slicing, sawing machinery, crushing, pressing, rolling machinery,
heating, cooking, baking equipment, cooling, refrigeration plant and equipment, conveyors and lifting plant,
electrical installation, radiation-based equipment, filling and bottling/packaging plant, other plant and machinery.
2. Mobile plant and transport includes: Self-propelled plant, semi-portable plant, other mobile plant, road transport, rail
transport, air transport, water transport, other transport.
3. Powered equipment, tools and appliances includes: Workshop and worksite tools and equipment, kitchen and
domestic equipment, office and electronic equipment, garden and outdoor powered equipment, Pressure-based
equipment not covered elsewhere, other powered equipment, tools and appliances.
4. Non-powered hand tools, appliances and equipment includes: Hand tools, non-powered, edged, other hand tools,
fastening, packing and packaging equipment, furniture and fittings, other utensils, ladders, mobile ramps and
stairways, and scaffolding, other non-powered equipment.
5. Chemicals and chemical products includes: Nominated chemicals, other basic chemicals, chemical products.
6. Material and substances includes: Non-metallic minerals and substances, other materials, objects or substances.
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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7. Environmental agencies includes: Outdoor, indoor and underground environments.
8. Animal, human and biological agencies includes: Live four-legged animals, other live animals, non-living animals,
human agencies, biological agencies.
9. Other and unspecified agencies includes: Non-physical and other and unspecified agencies
These categories are based on the break down agency of incident classifications listed in the Type of Occurrence
Classification System, Version 3.1 (TOOCS3.1). See this document at www.safeworkaustralia.gov.au for more detailed
information)
B7 High risk construction category
Select from the list of 19 high risk construction categories the one, if any, that relates to the incident. The high risk
construction categories are:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
Where there is a risk of a person falling two metres or more
On telecommunications towers
Involving demolition
Involving the disturbance or removal of asbestos
Involving structural alterations that require temporary support to prevent collapse
Involving a confined space
Involving excavation to a depth greater than 1.5 metres
The construction of tunnels
Involving the use of explosives
On or near pressurised gas distribution mains and consumer piping
On or near chemical, fuel or refrigerant lines
On or near energised electrical installations and services
In an area that may have a contaminated or flammable atmosphere
Tilt-up and precast concrete construction work
On or adjacent to roadways or railways used by road or rail traffic
Involving powered mobile plant
In an area where there are artificial extremes of temperature
In, over or adjacent to water or other liquids where there is a risk of drowning
Involving diving.
Part C – Injury details
A separate copy of this section should be completed for each worker who was injured as a result of the
incident. Do not complete this section for Dangerous Occurrences.
C1 Injured worker’s gender
Indicate if the injured worker is male, female or other.
C2 Injured worker’s age
Provide the injured workers age, in years. If the worker’s exact age is unknown, please provide an estimate of the
worker’s age.
C3 Who is the employer of the injured person?
Select one option from the three listed (accredited contractor, subcontractor or other). If the injured person is not
employed by the accredited contractor or a subcontractor, please select the “other” option. An example of a person
who may fit this category is Federal Safety Officer or Workcover auditor or other visitor to the site. If the person is an
unauthorised party (i.e. a trespasser or unauthorised member of the public), please provide details in this section.
C4 Subcontractor name or description for other (relates to C3)
If subcontractor or other was selected for the previous question (C3), please provide the name of the subcontracting
company or the nature of the person’s reason for being on site.
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C5 Worker’s occupation
Select one option only from the list which most accurately defines the injured worker’s usual occupation.
C6 Nature of injury
Select one option only from the list which best identifies the most serious injury (or disease) that was experienced by
the injured worker as a result of the incident.
Below are the kinds of injuries captured by each of the nature of injury categories:
A.
Intracranial injuries: Brain injury, other intracranial injury, not elsewhere classified or unspecified.
B.
Fractures: Fractured skull and facial bones, fracture of vertebral column without mention of spinal cord lesion,
other fractures, not elsewhere classified or unspecified.
C.
Wounds, lacerations, amputations and internal organ damage: Internal injury of chest, abdomen and pelvis,
traumatic amputation, injury to major blood vessel, laceration or open wound not involving traumatic amputation,
medical sharp/needle-stick puncture, superficial injury, contusion, bruising and superficial crushing.
D.
Burns: Electrical burn, chemical burn, cold burn, hot burn, friction burn, combination burn or burn not elsewhere
classified or unspecified.
E.
Injury to nerves and spinal cord: Quadriplegia involving spinal cord injury, paraplegia involving spinal cord injury,
injuries to nerves and spinal cord, not elsewhere classified or unspecified.
F.
Traumatic joint / ligament and muscle / tendon injury: Trauma to joints and ligaments, trauma to muscles and
tendons, residual soft tissue disorders due to trauma or unknown mechanisms.
G.
Other injuries: Foreign body on external eye, in ear or nose or in respiratory, digestive or reproductive tract,
poisoning and toxic effects of substances, audio shock, audio shriek, electrocution, shock from electric current,
traumatic deafness from air pressure or explosion, heat stress/heat stroke, hypothermia and effects of reduced
temperature, effects of weather, exposure, air pressure and other external causes, not elsewhere classified,
multiple injuries, other specified injuries, not elsewhere classified, or unspecified.
H.
Diseases and conditions: Musculoskeletal and connective tissue diseases, mental diseases, digestive system
diseases, skin and subcutaneous tissue diseases, nervous system and sense organ diseases,
I.
Respiratory system diseases, circulatory system diseases, infectious and parasitic diseases, neoplasms (Cancer),
other diseases, other claims.
(These categories are based on the nature of injury classifications listed in the Type of Occurrence Classification
System, Version 3.1 (TOOCS3.1). See this document at www.safeworkaustralia.gov.au for more detailed information)
C7 Location of injury
Select one option only from the list which identifies the part of the body affected by the most serious injury. The parts of
the body covered by each of the groups are listed below.
1.
Head: Cranium, eye, ear, mouth, nose, face - not elsewhere classified, head - multiple or unspecified locations.
2.
Neck: Neck.
3.
Trunk: Back - upper or lower, chest (thorax), abdomen and pelvic region, trunk - multiple locations/unspecified
locations.
4.
Upper limbs: Shoulder, upper arm, elbow, forearm, wrist, hand, fingers and thumb, upper limb - multiple or
unspecified locations.
5.
Lower limbs: Hip, upper leg, knee, lower leg, ankle, foot and toes, lower limb - multiple or unspecified locations.
6.
Multiple locations: Neck and trunk, head and neck, head and other, trunk and limbs, upper and lower limbs, neck
and shoulder, other specified multiple locations, unspecified multiple locations.
7.
Systemic location: Circulatory system, respiratory system, digestive system, genitourinary system, nervous
system, other and multiple systemic conditions, unspecified systemic conditions.
8.
Non physical locations: Psychological system.
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9.
Unspecified locations: Unspecified locations.
(These categories are based on the location of injury classifications listed in the Type of Occurrence Classification
System, Version 3.1 (TOOCS3.1). See this document at www.safeworkaustralia.gov.au for more detailed information)
C8 Mechanism of injury
Select one option only from the mechanism of injury list.
The mechanism of injury is the action, exposure or event which was the direct cause of the injury (i.e. ‘how’ the person
was hurt). Select one option from the list.
The mechanism is required in order to complete the variable “Number of LTIs by mechanism of injury reported by all
contractors in the course of the project”. The following list of standard categories is to be used when completing this
item. Entry is only required at group level but sub-groups are provided below to assist with selection of the appropriate
group.
Group 0 -FALLS, TRIPS AND SLIPS OF A PERSON
01 Falls from a height
02 Falls on the same level
03 Stepping, kneeling or sitting on objects
Group 1-HITTING OBJECTS WITH A PART OF THE BODY
11 Hitting stationary objects
12 Hitting moving objects
13 Rubbing and chafing
Group 2-BEING HIT BY MOVING OBJECTS
21
22
23
24
25
26
27
28
29
Being hit by falling objects
Being bitten by an animal
Being hit by an animal
Being hit by a person accidentally
Being trapped by moving machinery or equipment
Being trapped between stationary and moving objects
Exposure to mechanical vibration
Being hit by moving objects
Being assaulted by a person or persons
Group 3-SOUND AND PRESSURE
31
32
38
39
Exposure to single, sudden sound
Long-term exposure to sounds
Explosion
Other variations in pressure
Group 4-BODY STRESSING
41
42
43
44
Muscular stress while lifting, carrying, or putting down objects
Muscular stress while handling objects other than lifting, carrying or putting down
Muscular stress with no objects being handled
Repetitive movement, low muscle loading
Group 5-HEAT, ELECTRICITY AND OTHER ENVIRONMENTAL FACTORS
51
52
53
54
55
56
57
58
59
Contact with hot objects
Contact with cold objects
Exposure to environmental heat
Exposure to environmental cold
Exposure to non-ionising radiation
Exposure to ionising radiation
Contact with electricity
Drowning/immersion
Exposure to other environmental factors
Group 6-CHEMICALS AND OTHER SUBSTANCES
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61
62
63
64
69
Single contact with chemical or substance
Long term contact with chemicals or substances
Insect and spider bites and stings
Contact with poisonous parts of plant or marine life
Other and unspecified contact with chemical or substance
Group 7-BIOLOGICAL FACTORS
71 Contact with, or exposure to, biological factors of non-human origin
72 Contact with, or exposure to, biological factors of human origin
79 Contracts with, or exposure to, biological factors of unknown origin.
Group 8-MENTAL STRESS
81
82
84
85
86
87
88
Exposure to a traumatic event
Exposure to workplace or occupational violence
Work pressure
Suicide or attempted suicide
Other mental stress factors
Work related harassment and/or workplace bullying
Other harassment
Group 9-VECHICLE INCIDENTS AND OTHER
91
92
93
98
99
Slide or cave-in
Vehicle incident
Rollover
Other and multiple mechanisms of incident
Unspecified mechanisms of incident
(These categories are based on the 10 major mechanism of incident classification groups listed in the Type of
Occurrence Classification System, Version 3.1 (TOOCS3.1). See this document at www.safeworkaustralia.gov.au for
more detailed information)
C9 Working days / shifts expected /actually lost
Please note: This section only needs to be completed for Lost Time injuries (LTIs).
Indicate from the list, the number of working days or shifts that were lost for the injured worker as a result of the
incident. If the number of working days/shifts lost is not available at the time the report is required to be submitted
(because it is continuing past the required report submission due date), provide an indication of the working days/shifts
that are expected to be lost.
C10 Working days / shifts where a significant change to normal duties is made / expected
Please note: It is recommended that this section be completed for LTIs and AWIs, the latter of which the OFSC strongly
encourages the reporting of, but are optional. You may also complete this field for MTI’s that include AWI’s if that is
your company’s internal reporting practice.
Indicate from the list, the period (from days to months and days) that the injured worker has or is expected to have, at
the time the report is due for submission, a significant change to their normal duties upon return to work. This includes
where the injured worker has a gradual return to their normal duties or returns to work to perform a different role. For
example, a worker returns to work to perform administration duties where the usual duties involve intensive labour or
operation of mobile plant. This may also include workers sent to unscheduled training due to their incapacity to perform
normal duties.
Part D – Descriptive incident details
D1 Brief description of the incident
Provide a brief description (approximately 50 words) of the incident including what instigated it, the people, machinery
and equipment that were involved, and any injuries that were sustained as a result.
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D2 PLEASE ONLY COMPLETE IF REPORTING A FATALITY- Have you conducted an incident investigation
regarding the fatality?
Please only complete this section if you are reporting a fatality. The report asks for you to select yes or no and provide
the requested additional information corresponding to your response. If the information, such as an investigation report,
is not available at the time the report is due to be submitted, please make a note of this in this section of the report and
indicate when it is anticipated that the information will be available and forwarded to the OFSC.
D3 PLEASE ONLY COMPLETE IF REPORTING A FATALITY - Details
Please only complete this section if you are reporting a fatality. If you answered no to D2 please provide a response
outlining the actions that have been taken to reduce the risk of a similar future occurrence. An example of a response
to this question is “An incident investigation was conducted by Police, Worksafe and the Company, including a JSA and
WHSMS review. Toolbox meetings were conducted reinforcing WHSMS and WHS procedures”.
Part E – Details of person completing this form
This information is used to identify the source and validity of the form.
E1 Name
The name of the person completing the incident report form.
E2 Position
The job title of the person completing the incident report form.
E3 Date
The date that the incident report form was completed.
E4 Additional comments
Any additional comments relating to the incident or the report being submitted.
Please email, fax or post your completed form to:
Email:
FSCreporting@employment.gov.au
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
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OFSC Incident Report
This report should be completed for the following incident types where they occur on building or civil construction sites
and the accredited contractor is the head contractor (all subcontractor incidents should be included);



All fatalities on both Scheme and non-Scheme projects, irrespective of the project value (notify immediately to 1800
652 500 and provide report within 48 hours);
Any incident resulting in a LTI on a Scheme or non-Scheme project (the OFSC also encourages the reporting of
AWIs [Alternate Work Injuries]) where the project value is $3 million or more (provide report within 48 hours if a
Notifiable Incident, otherwise provide report within 3 weeks);
Any MTI or dangerous occurrence on a Scheme project (provide report within 48 hours if a Notifiable Incident,
otherwise provide report within 3 weeks. Non notifiable dangerous occurrences do not need to be reported to the
OFSC).
Part A - Project details
A1 Accredited contractor:
A2 Accreditation number:
A3 Contact person:
A4 Position:
A5 Telephone:
A6 Email:
A7 Construction type:
Commercial
Civil
Residential
Contract number (if OFSC Scheme project):
A8 Project name:
A9 Project value:
< $3 million
$3 million to < $10 million
$10 million or more
Part B - Incident details
B1 Date of incident:
B2 Time of incident:
B3 Project site location/address where incident occurred:
State/Territory:
B4 Incident type:
Dangerous Occurrence (must be notifiable at B5)
B5 Is this a notifiable incident *:
Yes
MTI
LTI
Fatality
No
B6 Breakdown agency of incident:
B7 High Risk Construction category:
(The main event that initiated the incident)
(The most significant risk category, if any, that relates to the incident)
1. Machinery and fixed plant
1. Where there is a risk of a person falling two metres or more
2. Mobile plant and transport
2. On telecommunications towers
3. Powered equipment, tools and
appliances
4. Non-powered hand tools,
appliances and equipment
3. Involving demolition
4. Involving the disturbance or removal of asbestos
5. Involving structural alterations that require temporary support to prevent
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5. Chemical and chemical products
collapse
6. Materials and substances
6. Involving a confined space
7. Environmental agencies
7. Involving excavation to a depth greater than 1.5 metres
8. Animal, human and biological
agencies
8. The construction of tunnels
9. Involving the use of explosives
9. Other and unspecified agencies
10. On or near pressurised gas distribution mains and consumer piping
11. On or near chemical, fuel or refrigerant lines
12. On or near energised electrical installations and services
13. In an area that may have a contaminated or flammable atmosphere
14. Tilt-up and precast concrete construction work
15. On or adjacent to roadways or railways used by road or rail traffic
16. Involving powered mobile plant
17. In an area where there are artificial extremes of temperature
18. In, over or adjacent to water or other liquids where there is a risk of
drowning
19. Involving diving
* Refer to page 25 for the definition of a notifiable incident
Part C - Injury details (complete for each worker injured by this incident, do not complete for Dangerous
Occurrences)
C1 Injured worker’s gender:
Male
Female
Other
C2 Injured worker’s age:
C3 Who is the employer of the injured person:
Accredited Contractor
Subcontractor (go to C4)
Other (go to C4)
C4 Subcontractor name or description for other (relates to C3):
C5 Worker’s
occupation:
(select one only)
C6 Nature of injury:
C7 Location of injury:
C8 Mechanism of injury:
(select one only)
(select one only)
(select one based on main
cause)
A. Intracranial injuries
1. Head
1. Labourers
B. Fractures
2. Neck
2. Tradesmen
C. Wounds, lacerations,
amputations and
internal organ damage
3. Trunk
D. Burns
6. Multiple locations
E. Injury to nerves and
spinal cord
7. Systemic location
3. Professional
4. Transport workers
5. Managers and
administrators
6. Clerical
7. Other
F. Traumatic
joint/ligament and
muscle/tendon injury
G. Other injuries
H. Diseases and
conditions
4. Upper limbs
5. Lower limbs
8. Non-physical
location
9. Unspecified
locations
0. Falls, trips and slips of a
person
1. Hitting objects with part of
the body
2. Being hit by moving
objects
3. Sound and pressure
4. Body stressing
5. Heat, electricity and other
environmental factors
6. Chemical and other
substances
7. Biological factors
8. Mental stress
9. Vehicle incidents and other
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C9 Working days/shifts expected/actually
lost:
C10 Working days/shifts where a significant change to normal
duties is made/expected:
(Select the appropriate duration)
(Select the appropriate duration)
A. 1 day to less than 3 days
A. 1 day to less than 3 days
B. 3 days to less than 1 week
B. 3 days to less than 1 week
C. 1 week to less than 2 weeks
C. 1 week to less than 2 weeks
D. 2 weeks to less than 1 month
D. 2 weeks to less than 1 month
E. 1 month to less than 3 months
E. 1 month to less than 3 months
F. 3 months or more
F. 3 months or more
Part D – Descriptive incident details
D1 Brief description of the incident:
ONLY COMPLETE D2 AND D3 IF REPORTING A FATALITY
D2 Have you conducted an incident investigation regarding the fatality?
Yes - please provide information regarding the investigation, such as a copy of the incident investigation report and
details of actions that have been subsequently taken to reduce the risk of a similar future occurrence. If the investigation
report is not available when submitting this report, please make a note of this on the report and indicate when it is
anticipated that the report will be forwarded to the OFSC.
No - please provide information at D3 regarding actions that have been subsequently taken to reduce the risk of a
similar future occurrence.
D3 Details:
Part E – Details of person completing this form
E1 Name:
E2 Position:
E3 Date:
E4 Additional comment:
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Sample OFSC Incident Report
On 16 April 2015, a notifiable incident, which was also an LTI occurred on the Contract D building site. At 9.30 am a
subcontractor lost his footing and fell as he was assisting another worker in moving a road barrier by hand. He injured
his right ankle, back and arms. He was given first aid on site and then sent to the hospital where it was revealed that he
had torn a ligament in his right ankle. Safety First Building Company Pty Ltd also conducted an incident investigation
including a JSA and WHSMS review, and organised for further WHS training to be provided to all workers. The next
day, Safety First Building Company Pty Ltd called a toolbox meeting attended by all workers where the importance of
strictly following WHSMS and WHS procedures was reinforced. Safety First Building Company Pty Ltd submits an
incident report to the OFSC on 18 May 2015.
Part A - Project details
A1 Accredited contractor: Safety First Building Company Pty Ltd
A2 Accreditation number: 12345
A3 Contact person: John Smith
A4 Position: WHS Manager
A5 Telephone: 01 8888 6666
A6 Email: jsmith@safetyfirstbcpl.com.au
A7 Construction type:
Commercial
Civil
Residential
Contract number (if OFSC Scheme project):
A8 Project name: Main Bridge Road Extension
A9 Project value:
< $3 million
$3 million to < $10 million
$10 million or more
Part B - Incident details
B1 Date of incident: 16 April 2015
B2 Time of incident: 09:30
B3 Project site location/address where incident occurred: 2189 main Road, Canberra
State/Territory: ACT
B4 Incident type:
Dangerous Occurrence (must be notifiable at B5)
B5 Is this a notifiable incident *:
Yes
MTI
LTI
Fatality
No
B6 Breakdown agency of incident:
B7 High Risk Construction category:
(The main event that initiated the incident)
(The most significant risk category, if any, that relates to the incident)
1. Machinery and fixed plant
1. Where there is a risk of a person falling two metres or more
2. Mobile plant and transport
2. On telecommunications towers
3. Powered equipment, tools and
appliances
3. Involving demolition
4. Involving the disturbance or removal of asbestos
4. Non-powered hand tools,
appliances and equipment
5. Involving structural alterations that require temporary support to prevent
collapse
5. Chemical and chemical products
6. Involving a confined space
6. Materials and substances
7. Involving excavation to a depth greater than 1.5 metres
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7. Environmental agencies
8. The construction of tunnels
8. Animal, human and biological
agencies
9. Involving the use of explosives
10. On or near pressurised gas distribution mains and consumer piping
9. Other and unspecified agencies
11. On or near chemical, fuel or refrigerant lines
12. On or near energised electrical installations and services
13. In an area that may have a contaminated or flammable atmosphere
14. Tilt-up and precast concrete construction work
15. On or adjacent to roadways or railways used by road or rail traffic
16. Involving powered mobile plant
17. In an area where there are artificial extremes of temperature
18. In, over or adjacent to water or other liquids where there is a risk of
drowning
19. Involving diving
* Refer to page 25 for the definition of a notifiable incident
Part C - Injury details (complete for each worker injured by this incident, do not complete for Dangerous
Occurrences)
C1 Injured worker’s gender:
Male
Female
Other
C2 Injured worker’s age: 40
C3 Who is the employer of the injured person:
Accredited Contractor
Subcontractor (go to C4)
Other (go to C4)
C4 Subcontractor name or description for other (relates to C3): JF & HF Building Contractors Pty Ltd
C5 Worker’s
occupation:
(select one only)
C6 Nature of injury:
C7 Location of injury:
C8 Mechanism of injury:
(select one only)
(select one only)
(select one based on main
cause)
A. Intracranial injuries
1. Head
1. Labourers
B. Fractures
2. Neck
2. Tradesmen
C. Wounds, lacerations,
amputations and
internal organ damage
3. Trunk
D. Burns
6. Multiple locations
E. Injury to nerves and
spinal cord
7. Systemic location
3. Professional
4. Transport workers
5. Managers and
administrators
6. Clerical
7. Other
F. Traumatic
joint/ligament and
muscle/tendon injury
G. Other injuries
H. Diseases and
conditions
4. Upper limbs
5. Lower limbs
8. Non-physical
location
9. Unspecified
locations
0. Falls, trips and slips of a
person
1. Hitting objects with part of
the body
2. Being hit by moving
objects
3. Sound and pressure
4. Body stressing
5. Heat, electricity and other
environmental factors
6. Chemical and other
substances
7. Biological factors
8. Mental stress
9. Vehicle incidents and other
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C9 Working days/shifts expected/actually
lost:
C10 Working days/shifts where a significant change to normal
duties is made/expected:
(Select the appropriate duration)
(Select the appropriate duration)
A. 1 day to less than 3 days
A. 1 day to less than 3 days
B. 3 days to less than 1 week
B. 3 days to less than 1 week
C. 1 week to less than 2 weeks
C. 1 week to less than 2 weeks
D. 2 weeks to less than 1 month
D. 2 weeks to less than 1 month
E. 1 month to less than 3 months
E. 1 month to less than 3 months
F. 3 months or more
F. 3 months or more
Part D – Descriptive incident details
D1 Brief description of the incident: Worker was assisting another worker to move a road barrier by hand. He lost his
footing on the uneven ground and fell, injuring his right ankle, lower back and right elbow. He was given first aid on site
and then sent to the hospital where it was found that he had torn a ligament in his right ankle. Doctor advised that 4 weeks
off work should be taken with a gradual return to normal duties over the following month as worker feels able.
ONLY COMPLETE D2 AND D3 IF REPORTING A FATALITY
D2 Have you conducted an incident investigation regarding the fatality?
Yes - please provide information regarding the investigation, such as a copy of the incident investigation report and
details of actions that have been subsequently taken to reduce the risk of a similar future occurrence. If the investigation
report is not available when submitting this report, please make a note of this on the report and indicate when it is
anticipated that the report will be forwarded to the OFSC.
No - please provide information at D3 regarding actions that have been subsequently taken to reduce the risk of a
similar future occurrence.
D3 Details:
Part E – Details of person completing this form
E1 Name: John Smith
E2 Position: WHS Manager
E3 Date: 18/05/2015
E4 Additional comment:
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Guide for completing the OFSC Biannual Activity Report
The Biannual Activity Report should be submitted by all accredited contractors on the following schedule:


1 January to 30 June (or any part thereof) report by 15 July the same year
1 July to 31 December (or any part thereof) report by 15 February the following year.
Contractors first accredited in June or December need not report until the following biannual period. Complete all parts
of the form and verify that all incident reports for the period have also been submitted. The Incident Report Form can
be found on page 31 of this WHS Performance Reporting Pack.
Below is detailed guidance on how to complete your Biannual Activity Report. A copy of the form and an
example of a completed form follows this guide.
Part A – General information
Identifies the project, period reported and contact details should the OFSC require any clarification on the information
provided in the form.
A1 Accredited contractor
Provide the name of the accredited contractor the report is being completed by.
A2 Accreditation number
Provide the accreditation number the OFSC has allocated to the accredited company. This is used to validate question
A1. If you are unsure of your accreditation number please contact the OFSC for further information.
A3 Contact person
Provide the name of the person to contact if the OFSC requires any clarification on the information provided in the
form.
A4 Position
Provide the nominated contact person’s job title. Please also specify the name of the company that employs this
person if different to the accredited contractor.
A5 Telephone
Provide the most convenient and available contact number for the nominated contact person.
A6 Email
Provide the email address for the nominated contact person.
A7 Biannual period covered: 6 months from_______ to _______of _______
Please provide the details of period and year this biannual report covers. Biannual reporting periods are for the six
month periods from 1 January to 30 June and 1 July to 30 December each year.
Part B – WHS data across all current building and construction work for your organisation
B1 Workers’ compensation premium rate during the period
Provide the workers’ compensation premium rate for each State and/or Territory your company operates in for the 6
month period you are reporting. Your insurer will be able to provide this figure to you. Please report the rate as a
percentage. If you are self-insured or have other workers compensation arrangements please complete the “other”
section and provide details.
B2 Number of accredited contractor employees during the period
Provide the total number of individuals, who are accredited contractor employees only, that have worked on building or
civil construction projects (irrelevant of project value) for the accredited contractor for any length of time, during the
specified period. Count each employee once only, even if they have worked on multiple projects in the reporting period.
Administrative staff not working on site are not to be included in this count.
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B3 Number of claims for the above employees all projects during the period
The number of workers’ compensation claims that were actioned for the employees counted in B2 that originated from
building or civil construction work performed. If claims carry through several reporting periods, these must be reported
during each period they continue through.
B4 Average cost per claim for all projects during the period
The average cost per claim is calculated using the following formula:
B5 Number and details of any pending or completed prosecution action against the contractor by a
State/Territory WHS authority during the period (include number with brief description of issues)
Provide the number and details of any prosecution action initiated or continuing in this period.
B6 Number of workplace fatalities during the period on a site at which the accredited contractor was the head
contractor
Provide the number of fatalities that occurred on the accredited contractor’s building and construction sites in the
reporting period. A fatality is a work related occurrence that results directly or indirectly in the death of a person. This
includes fatalities resulting from natural causes if they occur on the project site. If incident reports for any fatalities have
not been submitted to the OFSC, please forward them to the OFSC immediately.
Part C – WHS performance data for all Scheme projects
C1 Number of Scheme projects undertaken during the period
Please provide the number of Scheme projects the accredited contractor was the head contractor for during the
biannual period.
A Scheme project is a project that is directly or indirectly funded by the Australian Government which meets the
Scheme thresholds. Any contract for building work under a Scheme project must be carried out by an accredited
contractor.
Refer to Section 2 of this Performance Reporting Pack for further clarification of a Scheme project.
Please contact the OFSC if you are unsure if your project should be treated as a Scheme project. A contract
declaration form (which can be found in the OFSC Performance Reporting pack) needs to be submitted to the OFSC
for every Scheme project.
C2 Hours worked for all the accredited contractor employees and subcontractors on Scheme projects
(Commercial, Civil and Residential projects)
Provide the total number of hours worked by all employees of the accredited contractor and any subcontractors on
Scheme project sites during the biannual reporting period. Please provide the hours worked divided across each of the
construction category types (commercial, civil and residential). Where an exact figure is not available, the OFSC asks
that you provide an informed approximate.
Please select one type of construction for each project as a whole. Where a project involves more than one type,
please select the type for the largest portion of the project that is managed/conducted by the accredited company.
Please do not split hours within a single project for this section of the report.
Refer to Section 2 of this Performance Reporting Pack for clarification on types of building work.
If you are unsure which category a project falls within, please contact the OFSC for assistance.
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Part D – WHS performance data for all non-Scheme building and civil construction work where the accredited
contractor was the head contractor
Number of non-Scheme projects undertaken during the period
D1 Non-Scheme projects valued at < $3 million
D2 Non-Scheme projects valued at $3 million to < $10 million
D3 Non-Scheme projects valued at $10 million or more
Provide the number of all projects which are non-Scheme projects worked on by the accredited contractor as head
contractor during the biannual reporting period. Please provide the number of projects split between those projects
valued at less than $3 million, between $3 million and $10 million and more than $10 million.
See the guidance for C2 above for information on Commercial, Civil and Residential building work as
defined by the OFSC. If you are unsure which category a project falls within, please contact the OFSC for
assistance.
Total hours worked for all accredited contractor employees and subcontractors during the period
(Commercial, Civil and Residential projects)
D4 Hours worked for all projects valued at < $3 million
D5 Hours worked for projects valued at $3 million to < $10 million
D6 Hours worked for projects valued at $10 million or more
Provide the total number of hours worked by all employees of the accredited contractor and any subcontractors on the
sites of all non-Scheme projects during the biannual reporting period. Please provide the hours worked divided up by
those projects with a value of less than $3 million, between $3 million and $10 million, and more than $10 million.
See the guidance for C2 above for information on Commercial, Civil and Residential building work as
defined by the OFSC. If you are unsure which category a project falls within, please contact the OFSC for
assistance.
Number of non-Scheme incidents in the reporting period for projects valued at $3 million or more
The purpose of this question is to verify that all required incidents for the hours reported have been submitted to the
OFSC for the Commercial, Civil and Residential projects worked on during the reporting period with a value of $3
million or more. See the guidance for C2 above for information on Commercial, Civil and Residential building work as
defined by the OFSC. If you are unsure which category a project falls within, please contact the OFSC for assistance.
Provide the number of incidents that occurred on non-Scheme projects for each of the following categories:
D7 Dangerous occurrences
An incident where no person is injured, but could have been injured, resulting in Serious Personal Injury (which
requires a week or more away from work), Incapacity or Death. Also commonly called a “near miss”. Only dangerous
occurrences that are required to be reported under the
WHS legislation covering notifiable incidents in the jurisdiction the project is being undertaken are required to be
reported to the OFSC.
D8 MTIs
(Medically treated injury) - A work-related occurrence that results in treatment by, or under the order of, a qualified
medical practitioner (see below), or any injury that could be considered as being one that would normally be treated by
a medical practitioner but does not result in the loss of a full day/shift. This may include AWI’s if that is your company’s
internal reporting practice. Do not report first aid treated injuries in this category.
An injury includes physical injuries as well as instances such as where a worker experiences psychological stress due
to witnessing a traumatic event or being a victim of bullying, or if they required medical attention due to migraines
caused by exposure to chemicals or gas.
A qualified medical practitioner is defined as a person with a medical degree. The following would normally be
considered medical treatment:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
40











Treatment of partial or full thickness burns
Insertion of sutures
Removal of foreign bodies embedded in eye
Removal of foreign bodies from a wound if the procedure is complicated by the depth of embedment, size or
location
Surgical debridement
Admission to a hospital or equivalent for treatment or observation
Application of antiseptics during second or subsequent visits to medical personnel
Any work injury that results in a loss of consciousness
Treatment of infection
Use of prescription medications (except a single one-off dose administered on the first visit for minor injury or
discomfort)
Treatment (diagnosis and evaluation) by a Psychiatrist for mental illness or stress as a result of a workplace
occurrence.
The following on their own would not normally be considered medical treatment:




Administration of tetanus shot/s or booster/s
Physiotherapy
Diagnostic procedures such as X-rays or laboratory analysis, unless they lead to further treatment
Referral to/treatment by a Psychiatrist where the diagnosis is not a result of a workplace occurrence.
D9 LTIs
(Lost time injury) - A work related occurrence that results in a permanent disability or injury resulting in time lost from
work of one day/shift or more. Permanent disability is as defined in the legislation of the jurisdiction in which the project
is being undertaken.
An injury includes physical injuries (i.e. cuts, burns, fractures etc) as well as instances such as where a worker
experiences psychological stress due to witnessing a traumatic event or being a victim of bullying (and may require
time off work as a result), or experiences migraines as a result of exposure to chemicals or gas.
The OFSC strongly encourages accredited contractors to report AWIs, however the reporting of these injuries is
optional. The definition of an AWI for OFSC purposes includes where the injured worker has a gradual return to their
normal duties (ie works less than their normal hours) or returns to work to perform a different role. For example, a
worker returns to work to perform administration duties where the usual duties involve intensive labour or operation of
mobile plant. This may also include workers sent to unscheduled training due to their incapacity to perform normal
duties.
D10 Fatalities
Fatality - A work related occurrence that results directly or indirectly in the death of a person (including deaths due to
natural causes which occur on the project site).
Part E – Notices issued for building and civil construction work on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
Provide the number and a description for any notices issued in each of the four categories below. When completing
OFSC reports, the number of notices for the period is to include all notices issued to both the accredited contractor (as
the head contractor or as a subcontractor on a site) and any issued to subcontractors of the accredited contractor
working on site.
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41
E1 Improvement
An improvement notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued
by the relevant WHS authority.
In the various jurisdictions, a WHS inspector may issue an improvement notice if they believe someone has
contravened the Act or regulations, or that a contravention may continue to be repeated. The notice will identify the
provisions of the Act or regulations that have been, or may be contravened, the reasons for the notice, and a deadline
for remedial action. An improvement notice may also include directions about how to remedy a breach.
E2 Prohibition
A prohibition notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued by
the relevant WHS authority.
These notices are issued when a WHS inspector determines that there is a serious risk that needs urgent attention.
Prohibition notices are issued for any work that involves or will involve an immediate risk to the health, safety and
welfare of any person.
E3 Infringement
An infringement notice, as defined in the legislation of the jurisdiction in which the project is being undertaken, issued
by the relevant WHS authority.
WHS regulations may allow for infringement notices to be issued as an alternative to prosecution for an offence that is
not indictable.
E4 Other (e.g. enforceable undertaking)
A WHS related notice (other than an infringement, prohibition or improvement notice) issued by the relevant WHS
authority in the jurisdiction in which the project is being undertaken.
Part F – Indication of any high risk construction work performed on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
F1 High risk categories
If applicable, indicate if your company performed work on any non-Scheme projects valued at $3 million or more that
involved work in any of the 19 high risk construction categories below.
1. Where there is a risk of a person falling two metres or more
2. On telecommunications towers
3. Involving demolition
4. Involving the disturbance or removal of asbestos
5. Involving structural alterations that require temporary support to prevent collapse
6. Involving a confined space
7. Involving excavation to a depth greater than 1.5 metres
8. The construction of tunnels
9. Involving the use of explosives
10. On or near pressurised gas distribution mains and consumer piping
11. On or near chemical, fuel or refrigerant lines
12. On or near energised electrical installations and services
13. In an area that may have a contaminated or flammable atmosphere
14. Tilt-up and precast concrete construction work
15. On or adjacent to roadways or railways used by road or rail traffic
16. Involving powered mobile plant
17. In an area where there are artificial extremes of temperature
18. In, over or adjacent to water or other liquids where there is a risk of drowning
19. Involving diving.
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Part G – Positive WHS developments
G1 Details of any peer industry recognition for WHS performance of the accredited contractor during the
period
Provide details of any peer or industry WHS recognition or safety awards that the contractor has received in the
specified period. Include any awards that the contractor may have won in the areas of workplace safety initiatives and
any WHS leadership and contribution to safety categories. Also include any recognition of good WHS from other
contractors or clients.
G2 Details of any key WHS initiatives implemented by the accredited contractor during the period
Provide details of any WHS initiatives that were implemented in the biannual reporting period. Examples of such
initiatives may include companywide WHS training, health strategies such as sun protection or an alcohol or drugs
program. Please indicate the strategies used in the comments section.
G3 Any other relevant information
Provide any other relevant information relating to the WHS initiatives implemented by the accredited contractor during
this biannual reporting period.
Part H – Details of person completing this form
This information is used to identify the source and validity of the form.
H1 Name
The name of the person completing the biannual activity report form.
H2 Position
The job title of the person completing the biannual activity report form.
H3 Date
The date that the biannual activity report form was completed.
H5 Additional comments
Any additional comments relating to the company or the biannual report data being submitted.
Please email, fax or post your completed form to:
Email:
FSCreporting@employment.gov.au
Mail:
Office of the Federal Safety Commissioner
Reporting and Communication Team
GPO Box 9880
Canberra ACT 2601
Fax:
02 6276 7133
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
43
OFSC Biannual Activity Report
The biannual activity report should be submitted by all accredited contractors on the following schedule:


1 January to 30 June (or any part thereof) report by 15 July the same year
1 July to 31 December (or any part thereof) report by 15 February the following year
Contractors first accredited in June or December need not report until the following biannual period.
Please complete all parts of the form and verify that all incident reports for the period have also been
submitted.
Part A - General information
A1 Accredited contractor:
A2 Accreditation number:
A3 Contact person:
A4 Position:
A5 Telephone:
A6 Email:
A7 Biannual period covered: 6 months: (Check period and input year)
Period:
Jan-June /
July-Dec
Year:
Part B - WHS data across all current building and construction work for your organisation
B1 Workers’ compensation premium rate(s) during the period by State or Territory (only complete those that
are applicable for your company’s areas of operation):
State of operation
Workers’ compensation premium rate percentage %
NSW
VIC
NT
TAS
ACT
QLD
WA
SA
Other (Please give details)
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B2 Number of accredited contractor employees during the period:
B3 Number of claims for the employees at B2 for all projects during the period:
B4 Average cost per claim for all projects during the period:
B5 Number and details of any pending or completed prosecution action against the contractor by a State/Territory
WHS authority during the period (include number with brief description of issues):
B6 Number of workplace fatalities during the period on any site at which the accredited contractor was the head
contractor:
Part C - WHS performance data for all Scheme projects
Commercial
Civil
Residential
Commercial
Civil
Residential
C1 Number of Scheme projects undertaken during the period:
C2 Total number of hours worked for all accredited contractors
employees and subcontractors on Scheme projects
Part D - WHS performance data for all non-Scheme building and civil construction work where the accredited
contractor was the head contractor
Commercial
Civil
Residential
Commercial
Civil
Residential
D1 Number of non-Scheme projects valued at < $3 million during the
period
D2 Number of non-Scheme projects valued at $3 million to < $10 million
during the period
D3 Number of non-Scheme projects valued at $10 million or more during
the period
D4 Total hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at < $3
million
D5 Hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at $3
million to < $10 million
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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D6 Hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at $10
million or more
Number of non-Scheme incidents in the reporting period for projects valued at $3 million or more
Commercial
Civil
Residential
D7 Non- Scheme Dangerous occurrences
D8 Non-Scheme MTIs
D9 Non-Scheme LTIs
D10 Non-Scheme Fatalities
Part E - Notices issued for building and civil construction work on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
Number
Description
E1 Improvement:
E2 Prohibition:
E3 Infringement:
E4 Other (e.g. enforceable
undertaking):
Part F -Indication of any high risk construction work performed on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
F1 High risk construction categories (tick if applicable):
1. Where there is a risk of a person falling two
metres or more
11. On or near chemical, fuel or refrigerant lines
2. On telecommunications towers
12. On or near energised electrical installations and
services
3. Involving demolition
13. In an area that may have a contaminated or
flammable atmosphere
4. Involving the disturbance or removal of
asbestos
14. Tilt-up and precast concrete construction work
5. Involving structural alterations that require
temporary support to prevent collapse
15. On or adjacent to roadways or railways used by road
or rail traffic
6. Involving a confined space
16. On construction sites where there is any movement
of powered mobile plant
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
46
7. Involving excavation to a depth greater than
1.5 metres
17. In an area where there are artificial extremes of
temperature
8. The construction of tunnels
18. In, over or adjacent to water or other liquids where
there is a risk of drowning
9. Involving the use of explosives
19. Involving diving
10. On or near pressurised gas distribution mains
and consumer piping
Part G - Positive WHS developments
G1 Details of any peer or industry recognition for WHS performance of the accredited contractor during the
period:
G2 Details of any key WHS initiatives implemented by the accredited contractor during the period:
G3 Any other relevant information:
Part H – Details of person completing this form
H1 Name:
H2 Position:
H3 Date:
H4 Additional comments:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
47
Sample OFSC Biannual Activity Report
Part A - General information
A1 Accredited contractor: Safety First Building Company Pty Ltd
A2 Accreditation number: 12345
A3 Contact person: John Smith
A4 Position: WHS Manager
A5 Telephone: 01 8888 6666
A6 Email: jsmith@safetyfirstbcpl.com.au
A7 Biannual period covered: 6 months: (Check period and input year)
Period:
Jan-June /
July-Dec
Year: 2015
Part B - WHS data across all current building and construction work for your organisation
B1 Workers’ compensation premium rate(s) during the period by State or Territory (only complete those that
are applicable for your company’s areas of operation):
State of operation
Workers’ compensation premium rate percentage %
NSW
1.7
VIC
2.1
NT
TAS
ACT
QLD
WA
SA
Other (Please give details)
B2 Number of accredited contractor employees during the period: 35
B3 Number of claims for the employees at B2 for all projects during the period: 10
B4 Average cost per claim for all projects during the period: $1550
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B5 Number and details of any pending or completed prosecution action against the contractor by a State/Territory
WHS authority during the period (include number with brief description of issues): 0
B6 Number of workplace fatalities during the period on any site at which the accredited contractor was the head
contractor: 0
Part C - WHS performance data for all Scheme projects
Commercial
C1 Number of Scheme projects undertaken during the period:
0
Commercial
C2 Total number of hours worked for all accredited contractors
employees and subcontractors on Scheme projects
Civil
0
Residential
2
Civil
0
Residential
165,000
0
Part D - WHS performance data for all non-Scheme building and civil construction work where the accredited
contractor was the head contractor
Commercial
D1 Number of non-Scheme projects valued at < $3 million during the
period
Civil
Residential
1
0
0
D2 Number of non-Scheme projects valued at $3 million to < $10 million
during the period
0
2
0
D3 Number of non-Scheme projects valued at $10 million or more during
the period
0
1
0
Commercial
D4 Total hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at < $3
million
D5 Hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at $3
million to < $10 million
D6 Hours worked for all accredited contractor employees and
subcontractors during the period on non-Scheme projects valued at $10
million or more
Civil
Residential
13,000
0
0
0
64,230
0
0
29,370
0
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Number of non-Scheme incidents in the reporting period for projects valued at $3 million or more
Commercial
Civil
Residential
D7 Non- Scheme Dangerous occurrences
1
0
0
D8 Non-Scheme MTIs
2
4
0
D9 Non-Scheme LTIs
3
7
0
D10 Non-Scheme Fatalities
0
0
0
Part E - Notices issued for building and civil construction work on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
Number
E1 Improvement:
E2 Prohibition:
E3 Infringement:
E4 Other (e.g. enforceable
undertaking):
Description
0
2
Mobile Plant
0
0
Part F -Indication of any high risk construction work performed on non-Scheme projects with a value of $3
million or more where the accredited contractor was the head contractor
F1 High risk construction categories (tick if applicable):
1. Where there is a risk of a person falling two
metres or more
11. On or near chemical, fuel or refrigerant lines
2. On telecommunications towers
12. On or near energised electrical installations and
services
3. Involving demolition
13. In an area that may have a contaminated or
flammable atmosphere
4. Involving the disturbance or removal of
asbestos
14. Tilt-up and precast concrete construction work
5. Involving structural alterations that require
temporary support to prevent collapse
15. On or adjacent to roadways or railways used by
road or rail traffic
6. Involving a confined space
16. On construction sites where there is any movement
of powered mobile plant
7. Involving excavation to a depth greater than
1.5 metres
17. In an area where there are artificial extremes of
temperature
8. The construction of tunnels
18. In, over or adjacent to water or other liquids where
there is a risk of drowning
9. Involving the use of explosives
19. Involving diving
10. On or near pressurised gas distribution mains
and consumer piping
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
50
Part G - Positive WHS developments
G1 Details of any peer or industry recognition for WHS performance of the accredited contractor during the
period: State Civil Builders Association award for achievement in WHS by a medium sized company
G2 Details of any key WHS initiatives implemented by the accredited contractor during the period: Initiated sun
safety program on all sites, drug and alcohol awareness.
G3 Any other relevant information:
Part H – Details of person completing this form
H1 Name: John Smith
H2 Position: WHS Manager
H3 Date: 14 February 2015
H4 Additional comments:
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
51
Office of the Federal Safety Commissioner – Contract Declaration Form Guide - January 2015
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