About the person who had the accident
About you, the person filling in this record
About the accident
Where it happened (which room or place):
How did it happen? Give the cause if you can.
Were there any injuries?
What were the injuries?
First aid treatment received:
For the injured party
For management use only
Complete this section if the accident is reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). To report, go to www.hse.gov.uk/riddor/report.htm2
Was the accident reportable?
How was the accident reported?