Status:	Employee	Contractor	Other
Outcome:	Near miss	Injury
1. DETAILS OF INJURED PERSON
Name: Phone: (H) (W)
Address: Sex: M F
Date of birth:
Job Title:
Start time: am pm
Work arrangement:	Casual Full-time Part-time Other
2. DETAILS OF INCIDENT
Date: Time:
Location:
Describe what happened and how:





3. DETAILS OF WITNESSES
Name: Phone: (H) (W)
Address:

4. DETAILS OF INJURY
Nature of injury (e.g. burn, cut, sprain)
Cause of injury (e.g. fall, grabbed by person)
Location on body (e.g. back, left forearm)
5. TREATMENT ADMINISTERED
First aid given Yes No
First aider name:
Treatment:
Referred to:
SECTIONS 6–9 MUST BE COMPLETED BY EMPLOYER

6. DID THE INJURED PERSON STOP WORK?
Yes No If yes, state date: Time:
Outcome:
Treated by doctor Hospitalised Workers compensation claim
Returned to normal work Alternative duties Rehabilitation
7. INCIDENT INVESTIGATION (comments to include causal factors):




8. RISK ASSESSMENT
Likelihood of recurrence:
Severity of outcome:
Level of risk:
9. ACTIONS TO PREVENT RECURRENCE
Action	By whom	By when	Date completed

10. ACTIONS COMPLETED
Signed (Manager):
Title: Date:
Feedback to person involved Date:
11. REVIEW COMMENTS
WHS committee / staff meeting:
Reviewed by site Manager (signed): Date:
Reviewed by Health & Safety Rep.(signed): Date:

Risk assessment form

Details
Name: Position:
Risk details
Risk ID: Number allocated to this risk. Raised by: Name of person who has raised the risk. Date raised: Date of completion of this form.
Description of risk: Briefly describe the identified risk and its possible impact.
Likelihood of risk: Describe and rank the likelihood of the risk occurring (i.e. low, medium or high).	Impact of risk: Describe and rank the impact if the risk occurs (i.e. low, medium or high).
Risk mitigation
Preventative actions recommended: Briefly describe any action that should be taken to prevent the risk from occurring.
Contingency actions recommended: Briefly describe any action that should be taken, should the risk occur, to minimise its impact.
Approval details
Supporting documentation: Details of any supporting documentation used to substantiate this risk.
Signature: ________________________________________ Date: _____/_____/______

Risk register

This template is used to record identified risks associated with your project, analyse the impact and determine resultant action to be taken.

Risk	Likelihood (H/M/L)	Impact (H/M/L)	Risk response (contingency strategies)	Responsible

BSBMGT605B Provide Leadership across the organisation – Appendix 2 Page 5 of 26

Assessment Task 2 Templates

Action/implementation plan

Item	Milestone date	Responsibility

Budget

Project Name:
Income	Incl. GST	Excl. GST




Total income
Expense	Incl. GST	Excl. GST













Subtotal
Contingency (+10%)
TOTAL
Signature: ________________________________________ Date: _____/_____/______

Communication plan (example)

What	Who	Purpose	When/frequency	Type/methods
Initiation meeting	All stakeholders.	Gather information for initiation plan.	FIRST Before project start date.	Meeting.
Distribute project initiation plan	All stakeholders.	Distribute plan to alert stakeholders of project scope and to gain support.	Before kick-off meeting. Before project start date.	Project snapshot distributed via hard copy or electronically. May be posted on project website.
Project kick-off	All stakeholders.	Communicate plans and stakeholder roles/ responsibilities. Encourage communication among stakeholders.	At or near project start date.	Meeting.
Status reports	All stakeholders and project officer.	Update stakeholders on progress of the project.	Regularly scheduled. Weekly is recommended for small-medium projects.	Distribute status report electronically and post via website.
Team meetings	Entire project team. Individual meetings for sub-teams as appropriate.	To review detailed plans (tasks, assignments, and action items).	Regularly scheduled. Weekly is recommended for entire team. Weekly or bi-weekly for subteams as needed.	Meeting: detailed plan.
Sponsor meetings	Sponsor/s and Project Manager.	Update sponsor/s on status and discuss critical issues. Seek approval for changes to project plan.	Regularly scheduled. Recommended biweekly or monthly and also as needed when issues cannot be resolved or changes need to be made to project plan.	Meeting.
Media and community promotion	Marketing team.	Promote benefits of the project to community.	As determined by marketing team.	Internet Magazine Radio.

Assessment Task 3 Templates

Roles and responsibilities

Role	Name/s	Responsibilities	Signature/s (if required)

Budget

Project Name:
Income	Incl. GST	Excl. GST




Total income
Expense	Incl. GST	Excl. GST













Subtotal
Contingency (+10%)
TOTAL
Signature: ________________________________________ Date: _____/_____/______

Assessment Task 4 Templates

Professional development plan

Name

Date of development

Date to be reviewed

Discussed with mentor/colleague

Name:

Discussed with manager

Name:

Goals

Timeframe

My personal goals are:

These should relate to or support professional goals

My professional goals are:

These should relate to objectives to maintain current competence in the job role or future career paths.

Next 12 months

This will depend on type of activity priority/ importance of undertaking it

Next 5 years

This will depend on type of activity priority/ importance of undertaking it

Strengths and Weaknesses

Timeframe	Personal	Professional
Required knowledge/ skills Consider: · required competencies · job description · service plans and frameworks.
Strengths Consider: · your views · recent tests/appraisals · other people’s views.
Gaps/barriers/obstacles and solutions · gaps in knowledge/ skills · changes to systems/ services requiring new skills · what will help you to progress in your role, profession?

Professional Development and Networking Activities

Identified gap	Development activity	Details (provider, location, etc.)	Objective of development/ networking activity	Timeframe	Cost
1.
2.
3.
4.
5.

Third party report

Name of observer: Position: Contact details:
Skill	Description of how candidate demonstrated skill/knowledge. Provide example
Demonstrates interpersonal skills to communicate and inspire trust and confidence of others and to ensure their cooperation and support.
Demonstrates networking skills to ensure support from key groups and individuals for concepts/ideas/ products/services.
Applies business ethics.
Ensure performance is continuously improved through participation in professional development, networking, etc.
Signature: ________________________________________ Date: _____/_____/______

BSBMGT605

Appendix 1 – Templates

Table of Contents

Assessment Task 1 Templates

Assessment Task 2 Templates

Action/implementation plan

Budget

Assessment Task 3 Templates

Assessment Task 4 Templates

Goals

Strengths and Weaknesses

Professional Development and Networking Activities