Accident Report Form (New Zealand)

An Accident Report Form in New Zealand records the hazards, risks, controls, or incident details for a workplace activity to support a safe system of work under the Employment Relations Act 2000.

New Zealand's workplace health and safety framework is built on the Health and Safety at Work Act 2015, enacted following the recommendations of the Royal Commission on the Pike River Coal Mine Tragedy. The HSWA introduced the PCBU concept (replacing the previous 'employer' framing), strengthened the primary duty of care under section 36, created personal liability for officers (directors and senior managers) under section 44, and established WorkSafe New Zealand as the national workplace health and safety regulator under the WorkSafe New Zealand Act 2013.

The Accident Compensation Act 2001 (ACA 2001) establishes New Zealand's unique no-fault accident compensation scheme, administered by the Accident Compensation Corporation (ACC). Under the ACC scheme, virtually all personal injuries caused by accident are covered regardless of fault. Workers receive weekly compensation at 80% of pre-injury earnings up to a statutory maximum, cover for treatment costs including GP visits, surgery, physiotherapy, and medication, and rehabilitation support. In exchange, individuals give up the right to sue for personal injury caused by accident.

A completed Accident Report Form serves four critical functions under New Zealand law. First, it creates the factual record needed for an ACC claim lodged through a treating health provider. Second, it determines whether a 'notifiable event' has occurred under sections 25–31 of the HSWA 2015, triggering an obligation to notify WorkSafe NZ immediately on 0800 030 040 and preserve the incident scene. Third, it drives the root-cause investigation and corrective action process that is central to the PCBU's primary duty of care under section 36 of the HSWA 2015. Fourth, it creates the written record the PCBU must retain for at least five years under the HSWA 2015 to demonstrate compliance in the event of a WorkSafe NZ inspection or prosecution.

An Accident Report Form should be completed in New Zealand whenever a workplace accident, incident, or near miss occurs, regardless of whether an injury results. Specifically, you should complete an Accident Report Form when:

- A worker, contractor, volunteer, visitor, or member of the public is injured at your workplace or as a result of your work activities.

- A near miss occurs — an unplanned event that did not result in injury but had the potential to do so. Near misses are invaluable for identifying hazards before someone is hurt.

- Equipment is damaged in a way that could have caused injury.

- A worker is exposed to a hazardous substance or situation.

- A health complaint that may be work-related arises (e.g., an occupational disease).

- Any incident occurs that might be a 'notifiable event' under the HSWA 2015, requiring notification to WorkSafe NZ.

Completing an Accident Report Form promptly is important. Memories fade quickly, witnesses move on, and physical evidence at the scene may change. The PCBU should aim to complete the report within 24 hours of the incident. For notifiable events, WorkSafe NZ must be notified immediately, and the scene must be preserved.

PCBUs should also use Accident Report Forms as a management tool — analysing patterns in accidents and near misses to identify systemic hazards and implement controls before more serious incidents occur.

A thorough New Zealand Accident Report Form must include the following key sections to satisfy the requirements of the Health and Safety at Work Act 2015, support ACC claims under the Accident Compensation Act 2001, and withstand scrutiny by WorkSafe NZ inspectors.

1. Organisation details — The full legal name and address of the PCBU, the site or workplace address if different, the industry sector, and the name and position of the person completing the report. PCBUs must retain this record for at least five years from the notification date under the HSWA 2015.

2. Injured person details — Full name, date of birth, role and employment status (employee, labour-hire worker, contractor, visitor, or member of the public), contact details, and years of experience in the role. Experience data is relevant to assessing whether a competency gap or inadequate supervision contributed to the incident.

3. Accident details — Precise date, time, and location of the incident; the mechanism of injury (slip/trip/fall, fall from height, struck by object, machinery entanglement, exposure to hazardous substance, or other); a description of what the injured person was doing immediately before the incident; and a detailed factual narrative of how the incident unfolded.

4. Injury details — The nature and severity of the injury or illness; body parts affected; first aid treatment provided on site; whether the person was transported to hospital for immediate treatment; and details of any ongoing medical treatment. This section directly supports an ACC claim lodged through a treating health provider under the Accident Compensation Act 2001.

5. Notifiable event identification — A checklist of the categories of notifiable event under sections 25–31 of the HSWA 2015: death of a person; notifiable injury or illness (requiring immediate treatment other than first aid, resulting in hospital admission, causing incapacity for more than seven days, or involving amputation, bone fracture, serious laceration, serious eye injury, or crush injury); or notifiable incident (unplanned event exposing a person to serious risk). If the incident is a notifiable event, record the date and time of notification to WorkSafe NZ on 0800 030 040, the WorkSafe reference number, and confirmation that the scene was preserved.

6. Causes analysis — Immediate causes (the direct physical triggers: wet floor, unsecured load, missing guard); contributing factors (environmental conditions, equipment state, time pressure); and root causes (systemic organisational failures: inadequate hazard identification, insufficient training, absence of safe work procedures).

7. Corrective actions — A structured action plan listing each corrective measure, the person responsible, and the target completion date. Actions should address all identified causes at each level and be reviewed at the next health and safety committee meeting.

8. Witnesses — Full names, roles, and contact details of all witnesses. Witness statements should be collected promptly, as the PCBU must preserve evidence relevant to any WorkSafe NZ investigation.

9. Declaration — Signature, name, and position of the person completing the report, confirming the information is accurate and complete. The forms-legal.com Accident Report Form (New Zealand) provides a structured template covering all sections required under the HSWA 2015 and the Accident Compensation Act 2001.