Forms and templates

Document When to use it
First Alert Template To be used for initial alert
Safety Alert Template To be used once investigation is complete and learnings can be notified
Five Whys template [ xlsx 43.38 KB ] The Five Whys incident report template is used to record the investigation into Level 4 incidents. Please refer to TP.SS 01.01 for more information.
Short form ICAM [ xlsx 48.7 KB ] This short-form ICAM (Incident Cause Analysis Method) template follows the ICAM methodology and is used to record findings regarding the contributory factors of medium severity incidents and near misses. Please refer to TP.SS 01.01 for more information.
Full ICAM Report template [ docx 118.51 KB ] Comprehensive ICAM investigations are required for Level 1 and 2 incidents. This is a major investigation and this template is used to produce a comprehensive report. Please refer to TP.SS 01.01 for more information.
Monthly Safety Incident Report Template [ docx 80.5 KB ] All safety incidents are to be reported to Transpower by the fifth working day of the following month. This document includes forms to record Hours Worked, Lost Time Injury Summary Data, Positive Action Summary Data and Public Safety Incident/Hazard Summary Data.
Worksite Safety Plan Safety plan when working on site.