Title Page

  • Issue Number

  • Date of Event

  • Time of Event

  • Business Organisation

  • Business Function

  • Type of person involved

  • Name of person involved

  • Company

  • Name of first line manager

  • The direct line manager of the person involved (within OVO)

  • Name of second line manager

  • The manager that the first line manager reports to (within OVO)

  • Length of service of person involved

  • Type of risk

  • Task carried out at time of event

  • Location of event

  • Classify the event

  • This classification means nothing actually happened - there was no damage and no injury

  • This classification means that some adverse event occurred but there was no damage and there was no injury

  • There was an adverse technical event but no damage to third party property and no injury to any person

  • There has been a release to the environment but no third party property damage

  • Classify the vehicle event

  • Either:
    - A vehicle operated by a contracting partner; or
    - A vehicle owned or operated by a third party
    has been damaged by a contracting party whilst it is parked.

    For a vehicle to be classified as parked the ignition must be off and the handbrake applied. If this criteria cannot be met another RTC classification must apply.

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff for company business; or
    - A vehicle owned or operated by a third party;
    has been damaged whilst it is parked.

    For a vehicle to be classified as parked the ignition must be off and the handbrake applied. If this criteria cannot be met another RTC classification must apply

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff for company business; or
    - A vehicle owned or operated by a third party;
    has been damaged by some means other than direct contact with another vehicle;

    Typical examples of these types of events are stone chips, cracked windscreens, attempted or successful break-ins and/or vandalism

  • Either:
    - A vehicle owned or operated by a contracting partner; or
    - A vehicle owned or operated by a third party;
    has been damaged by a contracting partner by some means other than direct contact with another vehicle.

    Typical examples of these types of events are stone chips, cracked windscreens, attempted or successful break-ins and/or vandalism

  • - A vehicle owned or operated by a contracting partner; or
    - A vehicle owned or operated by a third party;
    has been damaged to an extent and in circumstances that do not qualify as significant.

    The contract partner's driver has contributed to the event through either their actions or omissions and it is reasonable to assume an insurer would hold them at least partially liable.

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff on company business; or
    - A vehicle owned or operated by a third party;
    has been damaged to an extent and in circumstances that do not qualify as significant.

    The OVO driver has contributed to the event through either their actions or omissions and it is reasonable to assume an insurer would hold them at least partially liable.

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff on company business; or
    - A vehicle owned or operated by a third party;
    has been damaged to an extent and in circumstances that do not qualify as significant.

    The OVO driver has NOT contributed to the event through either action or omission and it is reasonable to assume an insurer would NOT hold them at least partially liable.

  • - A vehicle owned or operated by a contracting partner; or
    - A vehicle owned or operated by a third party;
    has been damaged to an extent and in circumstances that do not qualify as significant.

    The contract partner's driver has NOT contributed to the event through either their action or omission and it is reasonable to assume an insurer would NOT hold them at least partially liable.

  • - A vehicle owned or operated by a contracting partner; or
    - A vehicle owned or operated by a third party;
    has been involved in circumstances that qualify as significant.

    A significant road traffic collision has a potential to cause major harm to people or the environment. These are normally defined by one or more of the following:
    - when someone involved requires Medical Treatment;
    - any vehicle involved completely leaves the road or overturns;
    - there is significant damage to any vehicle involved which as a result is unsafe to drive or requires to be towed or transported from the scene;
    - vehicle roll-away of >3m or the vehicle roll-away results in any of the above;
    - trailer or load being towed by any vehicle involved leaves the road, overturns or becomes detached; or
    - items fall from a moving vehicle, trailer or load being towed.

    An event is deemed accountable when the contract partner's driver has contributed to the event through either their actions or omissions and it is reasonable to assume an insurer would hold them at least partially liable.

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff on company business; or
    - A vehicle owned or operated by a third party;
    has been involved in circumstances that qualify as significant.

    A significant road traffic collision has a potential to cause major harm to people or the environment. These are normally defined by one or more of the following:
    - when someone involved requires Medical Treatment;
    - any vehicle involved completely leaves the road or overturns;
    - there is significant damage to any vehicle involved which as a result is unsafe to drive or requires to be towed or transported from the scene;
    - vehicle roll-away of >3m or the vehicle roll-away results in any of the above;
    - trailer or load being towed by any vehicle involved leaves the road, overturns or becomes detached; or
    - items fall from a moving vehicle, trailer or load being towed.

    The OVO driver has contributed to the event through either their actions or omissions and it is reasonable to assume an insurer would hold them at least partially liable.

  • - A vehicle owned or operated by a contracting partner; or
    - A vehicle owned or operated by a third party;
    has been involved in circumstances that qualify as significant.

    A significant road traffic collision has a potential to cause major harm to people or the environment. These are normally defined by one or more of the following:
    - when someone involved requires Medical Treatment;
    - any vehicle involved completely leaves the road or overturns;
    - there is significant damage to any vehicle involved which as a result is unsafe to drive or requires to be towed or transported from the scene;
    - vehicle roll-away of >3m or the vehicle roll-away results in any of the above;
    - trailer or load being towed by any vehicle involved leaves the road, overturns or becomes detached; or
    - items fall from a moving vehicle, trailer or load being towed.

    An event is deemed non-accountable when the contract partner's driver has NOT contributed to the event through either their action or omission and it is reasonable to assume an insurer would NOT hold them at least partially liable.

  • - A vehicle owned or operated by OVO (including temporary hires); or
    - A privately owned/operated vehicle being used by a member of OVO staff on company business; or
    - A vehicle owned or operated by a third party;
    has been involved in circumstances that qualify as significant.

    A significant road traffic collision has a potential to cause major harm to people or the environment. These are normally defined by one or more of the following:
    - when someone involved requires Medical Treatment;
    - any vehicle involved completely leaves the road or overturns;
    - there is significant damage to any vehicle involved which as a result is unsafe to drive or requires to be towed or transported from the scene;
    - vehicle roll-away of >3m or the vehicle roll-away results in any of the above;
    - trailer or load being towed by any vehicle involved leaves the road, overturns or becomes detached; or
    - items fall from a moving vehicle, trailer or load being towed.

    The OVO driver has NOT contributed to the event through either their action or omission and it is reasonable to assume an insurer would NOT hold them at least partially liable.

  • Third party property has been damaged or OVO equipment has been damaged, lost or stolen

  • Press the "green plus" once for each person injured (eg if two people injured - press the "plus" twice)

  • Detail of injured person
  • Type of person injured

  • Location of primary injury

  • Method of primary injury

  • Extent of primary injury

  • If someone has died or has been injured because of a work-related accident this may have to be reported. Not all accidents need to be reported, other than for certain gas incidents, a RIDDOR report is required only when:
    - the accident is work-related
    - it results in an injury of a type which is reportable.

    All deaths to workers and non-workers, with the exception of suicides, must be reported if they arise from a work-related accident, including an act of physical violence to a worker.

    The list of 'specified injuries' in RIDDOR 2013 replaces the previous list of 'major injuries' in RIDDOR 1995. Specified injuries are (regulation 4):
    - factures, other than to fingers, thumbs and toes
    - amputations
    - any injury likely to lead to permanent loss of sight or reduction in sight
    - any crush injury to the head or torso causing damage to the brain or internal organs
    - serious burns (including scalding) which covers more than 10% of the body and causes significant damage to the eyes, respiratory system or other vital organs.
    - any scalping requiring hospital treatment
    - any loss of consciousness caused by head injury or asphyxia
    - any other injury arising from working in an enclosed space which leads to hypothermia or heat-induced illness or requires resuscitation or admittance to hospital for more than 24 hours.

    Accidents must be reported where they result in an employee or self-employed person being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury. This seven day period does not include the day of the accident, but does include weekends and rest days. The report must be made within 15 days of the accident.

    Accidents must be recorded, but not reported where they result in a worker being incapacitated for more than three consecutive days. If you are an employer, who must keep an accident book under the Social Security (Claims and Payments) Regulations 1979, that record will be enough.

    Accidents to members of the public or others who are not at work must be reported if they result in an injury and the person is taken directly from the scene of the accident to hospital for treatment to that injury. Examinations and diagnostic tests do not constitute 'treatment' in such circumstances. There is no need to report incidents where people are taken to hospital purely as a precaution when no injury is apparent.

    In relation to RIDDOR, an accident is defined as a separate, identifiable, unintended incident, which causes physical injury.

    Employers and self-employed people must report diagnoses of certain occupational diseases, where these are likely to have been caused or made worse by their work: These diseases include (regulations 8 and 9):
    - carpal tunnel syndrome;
    - severe cramp of the hand or forearm;
    - occupational dermatitis;
    - hand-arm vibration syndrome;
    - occupational asthma;
    - tendonitis or tenosynovitis of the hand or forearm;
    - any occupational cancer;
    - any disease attributed to an occupational exposure to a biological agent.

  • An incident / event which results in an employee (of either OVO or a contracting party) being absent from work for a minimum of one day (excluding the day which the injury or illness occurred).

  • Management and care of a patient to combat disease or disorder but does not result in a lost time injury.
    It does include:
    - using prescription medications or non-prescription medications at prescription strength on the recommendation of a physician or other licensed health care professional;
    - administering immunisations e.g. Hepatitis B or rabies;
    - wound closing devices such as sutures, staples, surgical glue etc.
    - devices with rigid stays or other systems designed to immobilise parts of the body;
    - physical therapy or chiropractic treatment for a work-related injury.

    It does not include:
    - visits to a physician or other licensed health care professional solely for observation or counselling;
    - the conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g. eye drops to dilate pupils);
    - exercise recommended by a health care provider for employees who do not exhibit signs or symptoms of an injury or illness; or
    - first-aid

  • An injury which requires simple medical treatment that is self-administered or by a first aider, doctor or nurse but does not result in lost time or long-term medical care. These include:
    - using a non-prescription medication (or prescription medication at non-prescription strength);
    - tetanus immunisations;
    - cleaning, flushing or soaking wounds on the surface of the skin;
    - wound coverings such as bandages, band-aids, gauze pads etc. or using butterfly bandages or steri-strips;
    - use of surgical glue as a precaution to prevent infection - Note: If the surgical glue is being used to seal the surface of a minor wound to keep the wound clean and prevent infection then this is First Aid. If the surgical glue is being used to close a wound i.e. as a substitute for a suture or staple then this is a medical treatment injury;
    - use of steri-strips to close small wounds;
    - hot or cold therapy;
    - non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc;
    - using temporary immobilisation devices while transporting an accident victim (e.g. splints, slings, neck collars, back boards, etc.);
    - drilling of fingernail or toenail to relieve pressure, or draining fluid from a blister;
    - using eye patches;
    - removing foreign bodies from the eye using only irrigation or a cotton swab;
    - removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means;
    - using finger guards e.g. tubular dressing, or stalls.
    - use of a finger guard providing rigid support is a medical treatment injury;
    - massages other than physical therapy and chiropractic treatment;
    - drinking fluids for relief of heat stress.

  • An accident under which no treatment was required but physical pain has been endured. Typical examples include minor slips or trips, struck by object, bump to head etc

  • Selection is only appropriate to third parties. All reasonable endeavours should be made to establish extent of injury

  • Did the injury result in any absence from work or restriction of duties? Applies to OVO staff and contractors only. Choose no if injured party was a third party.

  • Date absence started (Day following event or later)

  • Date returned to work in any capacity

  • Date restricted duties started (Day following event or later. If absence involved will be same day as absence or earlier)

  • Date returned to full capacity

  • Was the injury work related?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.