Information
The injured person
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Engineer Name
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Tech Code/Employee Number
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Telephone Number
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Team Number
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Team Manager
About the site
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Job Number
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Address
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Exact location, Where on the property did the incident happen. Rear garden, driveway etc.
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Date and time incident occurred
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Type of Incident
What happened and remedial actions
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What Happened? What were you doing at the time of the incident? For example, what was the weather like, ground conditions, circumstances leading up to the incident.
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Remedial Action Taken
People involved
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Was anybody else involved in the incident?
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Name/s of anybody else involved in the incident?
Other Information
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Action taken at the scene following the incident
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Who took the actions
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Please describe the weather conditions
- Wet
- Dry
- Icy
- Windy
- Extreme Heat
- Extreme Cold
- Other
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If other please specify
Plant/Machinery involved
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Was any Plant/Machinery involved
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What BSKYB Plant/Machinery was involved
- BSkyB provided 13 rung Ladders (Single section)
- BSkyB provided 13 rung Ladders (Double section)
- BSkyB provided 13 rung Ladders (Triple section)
- Full fall arrest equipment (ladder mate, Microlite, cow tail ect)
- BSkyB provided Bosch Drill
- BSkyB provided Sat Meter
- BSkyB provided Service detector
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Additional Plant/Machinery involved
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Was it powered at the time
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Where any hazardous materials involved?
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Was PPE worn at the time?
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If yes what was used
- Hard Hat
- Goggle
- Ear Plugs
- Knee Pads
- Hi-Vis vest
- Gloves
- Dust Mask
