Form 5A - Queensland mining industry incident report form
Choose one of the options below
(Approved by Chief Inspectors of Mines under Section 281 of the Coal Mining Safety and health Act 1999 and Section 260 of the Mining and Quarrying Safety and Health Act 1999.)
- All fields are compulsory, unless otherwise stated.
- If the mine code you enter does not match a valid code in our records, you will not be able to submit this form
- This form does not replace the need for the site senior executive to notify an inspector of a serious accident or high potential incident in accordance with Section 198 of the Coal Mining Safety and Health Act 1999 or Section 195 of the Mining and Quarrying Safety and Health Act 1999.
- Mining industry incident report manual - online forms (PDF, 222 kB) - instructions/definitions for completion of this on-line incident report form