Hazardous Substance Injuries can optionally be notified in EpiSurv but MUST be formally reported to Massey University Hazardous Substances Disease and Injury Reporting Tool (HSDIRT).

In New Zealand, any injury or disease caused by hazardous substances must be notified to the Medical Officer of Health. For further information on notifying hazardous substances injury, please refer to Massey University’s HSDIRT Resources for health professionals page.

Exposure Event

Place of Exposure - Indicate the place of exposure. If the place of exposure is not listed tick ‘other’ and specify. If the place of exposure is not known tick ‘unknown’.

Date Exposure Began - Record the date the exposure began in dd/mm/yyyy format. If the date the exposure began is not known tick ‘unknown’.

Length of Exposure - Specify the length of exposure. If exposure was less than or equal to one day tick ‘acute’, if exposure was more than one day tick ‘chronic’ and if the length of exposure is not known tick ‘unknown’.

Injury - Indicate what type of hazardous substance injury occurred. Tick all that apply. If the type of injury is not listed tick ‘other’ and specify.

Poisoning Route - Indicate the route of poisoning. Tick all that apply. If the route of poisoning is not listed tick ‘other’ and specify.

Intent - Indicate the intent of injury/poisoning. Tick the appropriate box. If the intent is not known tick ‘unknown’.

Substance Details

Classification - Indicate the classification group of the hazardous substance involved in the injury. Tick all that apply. If the substance classification is known but is not listed tick ‘other’ and specify. If the substance classification is not known tick ‘unknown’.

Substance Name - Indicate the hazardous substance generic name and brand name. The generic name is the non-proprietary name or chemical makeup of the substance as opposed to the brand name under which the substance is marketed. For example, Glyphosate is the generic name and Roundup® is one corresponding brand name. If the substance name is not known tick ‘unknown’. If more than three substances were involved in the exposure event tick the relevant box and enter additional details in the comments section at the end of the form.

Laboratory Confirmation

Was the exposure confirmed by a lab test? - Indicate the status of laboratory confirmation. Tick the appropriate box.

Has a copy of the lab results been requested by the PHU? - Indicate whether a copy of the laboratory results has been requested by the PHU. If it is not known whether lab results have been requested by the PHU tick ‘Unknown’.

Has a copy of lab results been received by the PHU? - Indicate whether a copy of the laboratory results has been received by the PHU. If it is not known whether a copy of the lab results have been received by the PHU tick ‘Unknown’.