Accident Report Form

Please complete this Accident Report Form for every incident which could have led to injury – even if it did not lead to an injury on this occasion. Completion is mandatory after any such incident.

Name of person who had the accident
Are they a team member?
If they are not a team member, what are there contact details:
What is the name of the person filling in this form:
What is your email address?
Date of accident:
Time of accident:
Location of accident:
How did it happen?
If there were injuries, describe them:
Was any treatment given?
Have steps been taken to prevent a similar accident occurring again? (if so, what)
Word Verification: