Accident/Injury Report, Add new
ABOUT THE PERSON WHO HAD THE ACCIDENT
Name
Occupation/Role
Address
Town
Postcode
Tel
PERSON REPORTING THE ACCIDENT/INJURY
Name
Occupation/Role
Address
Town
Postcode
Tel
DETAILS OF THE ACCIDENT/INJURY
Accident Date
Where did the accident take place?
How the accident happened (give a cause if known)
Details of the accident/injury
Signed
Clear
Date of accident
22/10/2024
EMPLOYER'S USE ONLY
If this incident is reportable under RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurences Regulations 1995)
How was it reported?
Signed
Clear
Date
Submit
Reset
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