Incident Report

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date & Time

  Date

• Daily Log Reference

Casualty's Details

• Full Name

• Status

  Guest

  Visitor

  Employee

  Contractor

• Address

• Postcode

• Sex

  Male

  Female

  Other

• Date Of Birth

  Date

• Contact Number

• Email Address

Person Completing the Report

• Full Name

• Occupation: Security

• Address: One Waterview Drive, Greenwich Peninsula, SE10 0TW

• Email Address

  security@iclondon-theo2.com

  securitysup@iclondon-theo2.com

• Contact Number: 02084636873

Incident In Sumamry

• Date & Time

  Date

• Location

• Hospitalised?

  Yes

  No

  N/A

• Nature Of Injury

• Site Of Injury

• First Aid Rendered?

  Yes

  No

  N/A

• First Aider

Incident in Detail

• Record in detail as much about the incident as possible

Declaration

• I certify that the information provided above is true and accurate to the best of my knowledge

Casualty

• NAME

• SIGNATURE

  Sign

• DATE

  Date

Recorder

• Name

• Signature

  Sign

• Date

  Date

6. RIDDOR

• Is the accident reportable under RIDDOR ’13?

  Yes

  No

  N/A

• Information recorded on this form is held in compliance with the Data Protection Act 1998 and gathered for the purpose of analysing and recording accidents in accordance with UK legislation in particular, The Health and Safety at Work etc. Act (1974), and the Reporting of Injuries Diseases and Dangerous Occurrences Regulations (2013)