Report a Hazard 2018-03-07 17:11:06 Contact Us [email protected] 1300 766 380 PO Box 1051, Caloundra 4551 Report a Hazard Injured Worker Feedback Please complete the form below Hazard DescriptionIncident TypeWorkplace InjuryNear MissOtherWhat type of hazard would you like to report?Please make a selectionEquipment DamageSafety ImprovementUnsafe Work ConditionsOtherDescriptionDate Occured Date Format: DD slash MM slash YYYY Approx Time LocationHost Employer Address where the incident took place Suburb State Your DetailsYour Name First Last Email Address Phone NumberCAPTCHANameThis field is for validation purposes and should be left unchanged. Please complete the form below How was your initial introductionExcellentPretty goodNeutralNot so greatTerribleWhen you were initially contacted by Workplace Central after your incident/injury, how well did we introduce ourselves and our role in your rehabilitation? Was a mutually convenient discussion time arranged?ExcellentPretty goodNeutralNot so greatTerribleDid your Workplace Central rehabilitation co-ordinator arrange a mutually convenient time (either face-to-face or via telephone) to discuss your injury, needs and goals for your recovery?Did we maintain appropriate, regular contact?ExcellentPretty goodNeutralNot so greatTerribleHow well did Workplace Central’s rehabilitation co-ordinator maintain regular contact with you, your host employer, your medical practitioner and any other interested parties as nominated by you? Did we visit your work site enough?ExcellentPretty goodNeutralNot so greatTerribleDid Workplace Central’s rehabilitation co-ordinator attend adequate worksite visits to understand your work requirements?Did your return to work program meet your ongoing needs?ExcellentPretty goodNeutralNot so greatTerribleRate the appropriateness of your return to work program in terms of it being graduated to meet your ongoing needs.How would you rate our ongoing communication?ExcellentPretty goodNeutralNot so greatTerribleRate the ongoing appropriateness of the communication from Workplace Central’s rehabilitation co-ordinator?Did we explain available return to work options well?ExcellentPretty goodNeutralNot so greatTerribleHow well did Workplace Central’s rehabilitation co-ordinator explain available options to assist your return to work?Overall outcome?ExcellentPretty goodNeutralNot so greatTerribleHow would you rate the overall outcome of your workplace rehabilitation?Rehabilitation co-ordinator performanceExcellentPretty goodNeutralNot so greatTerribleHow would you rate the overall performance of Workplace Central’s rehabilitation co-ordinator?Industry*Please select your industryAccounting/FinanceAdvertising/Public RelationsAerospace/AviationAgriculture/FarmingArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LabourTechnologyTelecommunicationsTransportation/LogisticsOtherAdditional Comments of FeedbackHost Employer (The organization where you work)*I wish to be anonymous I wish to be anonymous Your Information will not be shared with your host employer.The information you provide below will be only used by Workplace CentralName First Last Phone NumberEmail Address CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
