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*
DD slash MM slash YYYY
Time*

: Hours

Minutes

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?
- Yes
- No

About the incident