Accident Report

Title Page

Site
Location
Date / Time
Site Manager Name
Reported By

Accident Report

Please ensure you read the below guidance notes prior to completing your report. It is imperative that the correct reporting procedure is followed depending on whether you are reporting a near miss, minor or major accident.
'Near Miss' Guidance Notes
This report is for an unplanned event that has the potential to cause but does not actually result in human injury, environmental or equipment damage or an interruption to normal operations.
'Minor Accident' Guidance Notes
This report is for an accident occurring on or off company premises that results in less than 4 hours of lost time and includes both employees and non-employees. Examples of injuries include minor scalds, burns, joint or muscle injuries, sprains or strains, minor cuts and abrasions.
'Major Accident' Guidance Notes
This report is for an accident occurring on or off company premises that results in over 4 hours of lost time and includes employees and non-employees.The injured person must be seen by a first aider and report the accident to management before leaving site on the day of the injury. Employees working "off site" must report the accident to the person in control of the site and obtain treatment, if required, at the nearest facility (First aider, Hospital etc.). They must report the accident to their manager as soon as possible by telephone and report in person immediately on return to site.
Site managers must immediately conduct a thorough investigation to determine the cause(s) of the accident and take action to prevent a repetition. All relevant documentation must be gathered and attached to the accident report by the H&S Manager.
Serious and reportable injuries must be reported to the company H&S Manager as soon as possible.
All near misses, minor and major accidents must be reported to the Leisure Health & Safety Manager. Please click on 'Yes' to confirm that you understand that this must be reported.
Select the type of report you wish to submit.

Click the '+' to record any near miss, minor accident or major accident.
Report Type
Name of person(s) involved
Was the person involved a visitor or an employee?
What is their job title?
Was the employee trained?
Please provide details
Reason for visit
Date/time of incident/accident
Location of incident/accident
- Adventure Golf
- Driving Range
- Foot Golf
- Golf Course
- Clubhouse
- Restaurant / Bar
- Car Park
- Other (please detail)
Please detail
Exact place of incident/accident (e.g. pirate ship on Adventure Golf course or 6th tee box on Golf Course)
Statement of person(s) involved in incident/accident (please provide full description of what happened)
Did the person(s) involved have any injuries or symptoms?
Please provide details
Did the person(s) involved receive any treatment?
Please provide detail (e.g. administered first aid, phoned ambulance etc)
Name of first aider(s)
Was there a witness to this incident/accident?
Witness name
Statement of witness(es) (please provide full description of what happened)

H&S Manager Comments

Please leave the H&S Manager comments box blank. The H&S Manager will add their comments after you have submitted your report.
H&S Manager comments

Managers Findings & Actions

What caused the incident/accident?
What immediate action was taken?
What future action is planned to prevent a re-occurrence?
Name of person(s) involved / injured (IP)
Was the person involved a visitor or an employee?
What is their job title?
Was the employee trained?
Please provide details
Reason for visit
Date/time of incident/accident
Location of incident/accident
- Adventure Golf
- Driving Range
- Foot Golf
- Golf Course
- Clubhouse
- Restaurant / Bar
- Car Park
- Other (please detail)
Please detail
Exact place of incident/accident (e.g. pirate ship on Adventure Golf course or 6th tee box on Golf Course)
Statement of person(s) involved in incident/accident (please provide full description of what happened)
Did the person(s) involved have any injuries or symptoms?
Please provide details
Did the person(s) involved receive any treatment?
Please provide detail (e.g. administered first aid, phoned ambulance etc)
Name of first aider(s)
Was there a witness to this incident/accident?
Witness name
Statement of witness(es) (please provide full description of what happened)

Managers Findings & Actions

What caused the incident/accident?
What immediate action was taken?
What future action is planned to prevent a re-occurrence?

H&S Manager Comments

Please leave the H&S Manager comments box blank. The H&S Manager will add their comments after you have submitted your report.
H&S Manager comments
Name of person(s) involved / injured (IP)
Home address of person involved
Date of birth of person involved
Was the person involved a visitor or an employee?
What is their job title?
How long have they been employed?
What were their planned/actual hours of work on the day of the accident?
Was the employee trained?
Please provide details
Reason for visit
Date/time of accident
Location of accident
- Adventure Golf
- Driving Range
- Foot Golf
- Golf Course
- Clubhouse
- Restaurant / Bar
- Car Park
- Other (please detail)
Please detail
Exact place of accident (e.g. pirate ship on Adventure Golf course or 6th tee box on Golf Course)
Statement of person(s) involved in accident (please provide full description of what happened)
Did the person(s) involved have any injuries or symptoms?
Please provide details
Did the person(s) involved receive any treatment?
Please provide detail (e.g. administered first aid, phoned ambulance etc)
Name of first aider(s)
Was there a witness to this accident?
Witness name
Statement of witness(es) (please provide full description of what happened)

Managers Findings & Actions

What caused the accident?
What immediate action was taken?
What future action is planned to prevent a re-occurrence?

H&S Manager Comments

Please leave the H&S Manager comments box blank. The H&S Manager will add their comments after you have submitted your report.
H&S Manager comments
If an employee was involved, what was their return to work date?
How many hours did the employee loose?
Medical diagnosis from doctor/hospital
Indicate which of the following documentation is attached to this report:
Riddor form F2508 (required for over 7 day or major injury only)
Photographs of scene of accident/equipment in use at time
Statements from witnesses
Risk assessment documentation
Safe System of Work (operating procedure)
Safety inspection record (safety sampling, work equipment etc.)
Training records
Personal protective equipment issue record