Report Workplace Incidents to WorkSafe New Zealand Efficiently

When a notifiable event occurs at your New Zealand workplace—whether it's a serious injury, illness or dangerous occurrence—you're legally required to notify WorkSafe New Zealand immediately. This WorkSafe Notifiable Event Report template helps businesses across New Zealand capture all the critical information required under the Health and Safety at Work Act 2015, ensuring you meet your compliance obligations while documenting the incident thoroughly.

Built for New Zealand Health & Safety Compliance

This form is specifically designed for New Zealand employers, health and safety officers, and site managers who need to report notifiable events to WorkSafe. It captures everything from emergency services notification times and injured worker details to immediate causes and witness statements, giving you a complete record that satisfies regulatory requirements while supporting your internal investigation process.

Whether you're in construction, manufacturing, hospitality, agriculture or any other industry, this template ensures you're documenting incidents consistently and completely—reducing the risk of compliance penalties and helping you identify patterns that can prevent future events.

What Makes This Template Essential

• Regulatory-ready structure: Captures all information WorkSafe expects, including PCBU details, worker information, injury classification and immediate causes
• Emergency response tracking: Records exact times emergency services were notified and arrived, critical for compliance and internal review
• Conditional logic: Shows relevant fields based on injury type and severity, keeping the form streamlined
• Witness management: Collects multiple witness statements in one submission
• Instant notifications: Set up Stepper workflows to automatically alert your health and safety team, management and ACC when serious incidents are reported

Automate Your Incident Response with Stepper

Connect this form to Stepper to build a complete incident management workflow: automatically create tasks for follow-up investigations, send notification emails to WorkSafe and internal stakeholders, update your health and safety register in Airtable or Google Sheets, and trigger ACC claim processes—all without manual data entry.

Designed for Speed When It Matters Most

Serious incidents require immediate action. This form is optimised for fast completion on any device, so your team can report from the worksite using a mobile phone or tablet, ensuring WorkSafe receives timely notification and your investigation starts with accurate, complete information.

Paperform's SOC 2 Type II compliance and New Zealand data residency options give you confidence that sensitive incident data is handled securely, while conditional logic ensures only relevant questions appear based on the type of event being reported.