Oskomera Accident/Incident/Near Miss/Dangerous Occurrence Close out

• Document No.

• Audit Title

• Accident/Incident /Near Miss/Dangerous Occurrence Close Out

• Client / Site

• Mount Anvil Construction site
  Buckhold Road
  Wandsworth,
  London, SW18 4WW

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Type of event

• Fatal

• Major/Serious

• Minor

• Near Miss

• Damage to property/business only

• Injury

• I'll health

• Medical Condition/Incident

• Is the incident RIDDOR reportable

  Yes

  No

  N/A

• Has the documentation been completed and sent

  Yes

  No

  N/A

• Accident book completed

  Yes

  No

  N/A

• Photographs taken

  Yes

  No

  N/A

• Employee and witness statement taken

  Yes

  No

  N/A

• Maintenance Records

  Yes

  No

  N/A

• Any associated documentation with work activity

  Yes

  No

  N/A

Address Location, Area of Incident

• Add location
  Address

Details of Injured person

• Date and Time of Incident

  Date

Description of incident : Consider what, why, how, who

Description of any equipment involved

• Image of equipment being used

  Media

• Serial Number

  Yes

  No

  N/A

Training of employee List of courses and dates of courses

List of safe systems of work, risk assessment, policies etc appropriate to the work activity

• Action Taken:

  Yes

  No

  N/A

• Questions / Concerns Raised:

  Yes

  No

  N/A

• Name of manager informed at earliest opportunity

• Select date

  Date

• Further action taken:

  Yes

  No

  N/A

Actions completed and report closed out

• Add signature

  Sign

• Manager to close report on completion and distribute as appropriate.
  Include details of incident within any health and safety meetings and other relevant meetings
  Ensure any lessons learnt are circulated