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Report an Incident or Accident
Use this form to report incident or accidents at The PumpHouse Theatre. The first section is about the person completing this form.
Name
*
First
Last
Phone
*
Email
*
About the incident
Type of Incident
*
Injury
Damage
Close Call
Other
Please Specify
*
Date
*
Time
*
:
HH
MM
AM
PM
Please describe what happened
*
Who was involved?
*
Notifiable Events
*
If someone was seriously hurt you may need to report the accident to WorkSafe NZ immediately.
Find out more online at
http://www.worksafe.govt.nz/worksafe/notifications-forms/notifiable-events
After notifying WorkSafe, please notify The PumpHouse Theatre Business Manager on 021 637 687
Was this event notified to WorkSafe?
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