Third party health and safety form

As a provider working under contract with us, you must report health and safety incidents using this form.

All other providers treating our clients should consider contacting us when there are threats, incidents, or risks to your work with us. This includes:

  • personal threats – against you, your employees, another provider, or an ACC employee
  • organisational threats – to a place of business such as your practice or ACC locations
  • any other risks that make you feel unsafe or you believe could cause harm - to you or other healthcare providers supporting the client. This includes adverse client behaviour such as bullying or harassment, or sexualised conduct.

If you not under contract with ACC, you can notify us of a health and safety incident using the contact details below.

Health providers not under contract, contact the provider helpline.

Phone 0800 222 070.

Non-health suppliers, contact our procurement team. 

Email procurement@acc.co.nz.

If you have questions or feedback regarding the incident form please also email our procurement team. 

Your privacy

When we collect, use and store information, we comply with the Privacy Act 2020 and the Health Information Privacy Code 2020. For more information read our privacy policy.

Our privacy framework

 

What type of provider are you?
A ‘health provider’ is an ACC supplier who has a contract to deliver rehabilitation or treatment goods or services to ACC clients. A ‘non-health’ provider is a supplier who has a contract to deliver any other goods or services to ACC
Does this relate to a ACC claim?
What are you reporting?
Where did this happen?

Notifiable event details

As it is a notifiable event, you also need to notify Worksafe. Please contact them as well.

Type of notifiable event

Threat details

What type of threat are you reporting?
Were the police notified?
Have you spoken with someone at ACC?