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Notification of Incidents

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Guidance Note 04


A form must be sent to NSW DPI if there is an incident prescribed by the Coal Mine Health and Safety Act 2002 (the Act) and Regulation 2006 (the Regulation) at a mine. Please consider the Act and Regulation and the following dot
points when completing and sending the form:
• You are required by law to send an incident form to NSW DPI for work-related incidents. The prescribed
incidents are identified in the following tables.
• Where an incident is reportable under multiple clauses, each clause is to be referenced on the notification.
• You must keep a copy of any incident form that you send to NSW DPI for at least 5 years.
• You must send the form to your nearest regional NSW DPI Mineral Resources office.
• You can e-mail the form to the address below. You must still send the original form unless you attach a digital
signature of an authorised person.
• You may send additional information with the form including sketches, photos, plans, etc.
• Preliminary telephone advice will assist classification and prompt response.
• It is expected 7-day limit items will be reported during the next working day after becoming aware of incident.

Note about the Clauses on this Guidance Note: The notifiable clauses listed below are not in the same order as in the Act or Regulation. To help you complete the form, they are instead grouped by Incident Cause, Nature of Injury and Outcome of injury or illness.


Department of Industry and Investment New South Wales

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Relates to New South Wales (NSW)

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