Mandatory injury report

Under Australian Consumer Law, suppliers are required to report any product-related death, serious injury or serious illness associated with a consumer product. 

Who should use this form

  • Retailers
  • Suppliers, wholesalers or distributors of consumer products
  • Importers or manufacturers of consumer products
  • Providers of product-related services (e.g. installation, repair of consumer products)

Who should NOT use this form

  • Suppliers of therapeutic goods should report adverse events to the TGA 
  • Suppliers of pesticides and veterinary medicines should report to the APVMA 
  • Food-borne infectious diseases/pathogens are reportable to health authorities. However, other kinds of food-related incidents must be reported if the reporting criteria are satisfied (e.g. serious injury from food-packaging and anaphylactic reactions)
  • Motor vehicle accidents are only reportable to the ACCC if they occur off-road or on private roads/driveways
  • Consumers should contact the supplier of the potentially hazardous product or report an unsafe product to the ACCC
  • Suppliers and manufacturers of non-consumer products
  • Read the mandatory reporting guidelines for a full list of reporting exemptions

Complete all fields on this form to the extent that is known at the time the notice is given.

If you have any problems filling in this form please call 1300 302 502 or email mandatoryreporting@accc.gov.au.

Required fields indicated by: Required field

Multipage

Step 1 of 3 Contact details

Your agency details
Contact details
The ACCC will contact this person for additional information.
Supplier responsible for this product
Other suppliers
Order

Other supplier 1

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Step 2 of 3 Product details

Product details
If you are unable to find an appropriate category, please select "Unknown".
More than one country can be selected.
Identifying numbers
e.g. 28 Apr 2017
e.g. 28 Apr 2017
Attach list of identifying numbers
A maximum of 5 documents are allowed
More information
  • Files must be less than 3 MB.
  • Allowed file types: txt xls xlt xlsx xltx xlsb pdf doc docx dotx png gif jpg jpeg bmp.
Photograph(s) of product
A maximum of 5 photographs are allowed
More information
  • Files must be less than 3 MB.
  • Allowed file types: jpg jpeg png gif bmp.
Other supporting documentation
A maximum of 5 documents are allowed
More information
  • Files must be less than 3 MB.
  • Allowed file types: jpg jpeg png gif txt xls xlt xlsx xltx xlsb pdf doc docx dotx.
Dates product was supplied
Order
e.g. 28/04/2017
e.g. 28/04/2017
Recall details
For more information on the requirements for a recall notification, see Section 128 of the Australian Consumer Law (opens in new window).

Depending on the reason for the recall, please provide the following information below:

  • The nature of the defect or dangerous characteristic.
  • The circumstances in which use or misuse of the good may be dangerous.
  • The nature of the non-compliance or likely non-compliance of the product with a safety standard.
  • The interim or permanent ban that is in force.
In addition to any remedies you intend to offer as part of the recall you may also be liable to provide additional remedies under the Consumer Guarantees provision of the Australian Consumer Law. Please see Consumers' rights & obligations (opens in new window) for more information.
Please also include information on how consumers should contact you.
Regulators details
Media
Attach recall advertisement and supporting documents
A maximum of 5 documents are allowed
More information
  • Files must be less than 3 MB.
  • Allowed file types: txt xls xlt xlsx xltx xlsb pdf doc docx dotx png gif jpg jpeg bmp.
Marketing
Stock details
Under Section 131 of the Australian Consumer Law (opens in new window) you are required to provide details of the goods subject to the Mandatory Report, including quantities of goods manufactured in Australia, supplied in Australia, imported into Australia or exported from Australia.
Approximate quantities supplied
If you know where the product was sold, please provide details.
Attach list of traders who sold the product
A maximum of 5 documents are allowed
More information
  • Files must be less than 3 MB.
  • Allowed file types: txt doc xls xlt xlsx xltx xlsb pdf ppt pps docx png gif jpg jpeg.
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Step 3 of 3 Injury & incident details

Serious illness or injury means an acute physical injury or illness requiring medical or surgical treatment by, or under the supervision of, a qualified doctor or nurse.
Suppliers are required to report any death, serious injury or illness that they become aware of and that someone believes was caused by the use of a consumer good or service they supply. If you want to submit the mandatory injury report now, you can provide us with the details of the incident below, and your submission will be considered a recall notification and mandatory injury report.

If you have previously notified the ACCC of the incident(s), you do not need to provide this information again.
Incident details

Type of incident

Serious illness or injury means an acute physical injury or illness requiring medical or surgical treatment by, or under the supervision of, a qualified doctor or nurse.

Specific incident details
Please provide specific details of each incident, additional incidents can be added with the button below.
Order

Incident 1

e.g. 28/04/2017
e.g. 28/04/2017
e.g. 28/04/2017
e.g. 10:45 AM
e.g. 28/04/2017
e.g. 10:45 AM
Affected person

The particulars of the injured person are used to help identify a single incident when the ACCC receives reports from multiple sources.

It is the reporter's responsibility to ensure that providing this information is not in breach of privacy laws in the reporter's jurisdiction. You may need to obtain the person's consent to provide these details to the ACCC.

Business where product was purchased or consumed