Audit

An accident is an unplanned event that results in an injury or could have resulted in an injury or results in damage to equipment or property. Anyone can complete an accident report form. Once completed the form should be sent to the Health and Safety manager at Silverhills.

Details of any Injured Person

Full Name

Status

Address & Postcode if a Subcontractor or Visitor

Telephone number &/ contact details

Details of accident / incident
Date of occurrence
Time of occurrence

Location of occurrence

What happened. Give cause (how & why) if known

Photos if applicable
Nature of Injury

Details of injury

Treatment given

Treatment given by

Taken to hospital

Which hospital, & how were they taken

Off work as a result of their injury

If Yes, for how many days

Any further information

Environmental Conditions

Weather

Wind speed

Any other remarks

Photos if applicable
Details of person completing this report

Full Name

Status

Address & Postcode if a Subcontractor or Visitor

Telephone number &/ contact details

Signature
Date
For completion by the company Health and Safety Officer

Accident / Incident investigated Yes / No

Written investigation report necessary Yes / No

Written investigation report completed Yes / No

RIDDOR reportable Yes / No

If Yes, date reported:

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.