Platinum Accident Report - V2

The information contained within this report is confidential and must not be shared with anyone without permission from the Senior Management Team. Do not alter and disturb the incident site and ensure photos are attached to this report of both the injury and location of the injury.

Title Page

Conducted on
Prepared by
Location

About the Person & Injury

Date and Time of the Incident
Name of Injured Person
Injured Person's Department
- Goods In
- Warehouse & Stores
- Horizon Assembly
- Curve Assembly
- Ultimate Assembly
- Kit Box
- Chair Shop
- Horizon Rail Prep
- Paint Shop
- Curve Rail Shop
- Ultimate Rail Shop
- Research & Design
- Installations & Fitters
- Technical Support
- Operations Office
- Finance Office
- Sales Office
- Execs
- External Sales
- Visitor
- Contractor
- Other
Location Injury Took Place
- Goods In
- Warehouse & Stores
- Horizon Assembly
- Curve Assembly
- Ultimate Assembly
- Kit Box
- Chair Shop
- Horizon Rail Prep
- Paint Shop
- Curve Rail Shop
- Ultimate Rail Shop
- Research & Design
- Installations & Fitters
- Technical Support
- Operations Office
- Finance Office
- Sales Office
- Execs
- External Sales
- Visitor
- Contractor
- Other
Location if not listed in dropdown options
Location on body of injury
- Head / Scalp
- Face
- Neck
- Shoulders
- Left upper arm
- right upper arm
- left lower arm
- Right lower arm
- Left Wrist
- Right wrist
- Left Hand
- Right Hand
- Chest
- Stomach
- Groin
- Upper left leg
- Upper right Leg
- Left knee
- Right knee
- Left Lower leg
- Right lower leg
- Left ankle
- Right ankle
- Left foot
- Right foot
Exact location of injury - Example - left hand index finger
- Head / Scalp
- Face
- Neck
- Shoulders
- Left upper arm
- right upper arm
- left lower arm
- Right lower arm
- Left Wrist
- Right wrist
- Left Hand
- Right Hand
- Chest
- Stomach
- Groin
- Upper left leg
- Upper right Leg
- Left knee
- Right knee
- Left Lower leg
- Right lower leg
- Left ankle
- Right ankle
- Left foot
- Right foot
Type of injury
- Laceration
- Chemical Burn
- Eye Injury
- Inhalation of dust / foreign body
- Strain or Sprain
- Bruising
- Graze / Scratch
- Broken Bone
- Contact burn
- Electric Shock
- Medical Condition
- Other
If Injury Type is not listed, please give details below
- Yes
- No
- N/A
Attach photos of the injury - ensure permission is granted from the injured person before this is done

About the Incident

Please provide as much detail as possible about the incident which has caused the injury. Ensure the information entered is factual and not an opinion.
Give details of how the accident occurred - ensure this is the information provided to you by the inured person
where there any witnesses to the incident?
Provide names of witnesses
Provide the type of first aid treatment given
Location of injured person
- Returned to Work
- Returned to work on altered duties
- Taken to A & E by PSL Employee
- Ambulance attended and taken to A & E
- Left site and returned home
Provide photos of the location of the incident