Title Page

  • Incident location

  • Prepared by

  • Is the incident reportable to RIDDOR?

  • Specify the incident.

RIDDOR Report

Section 1: Company and Incident Reporter Information

  • Name of company/organisation

  • Address of company/organisation
  • Name of incident reporter

  • Job title

  • Contact number

  • Email address

Section 2: Person(s) Affected

    Person Affected
  • Name

  • Date of birth

  • Home address

  • Contact number

  • Job title

  • Position

  • Specify

Section 3: Incident Information

  • Date of the incident

  • Time of the incident

  • Location of the incident

  • Specify which department or area the incident took place.

  • Specify the exact location.
  • Kind of incident

  • How high was the fall (in metres)?

  • Specify the type of incident.

  • Are there any witnesses?

  • Witness
  • Name

  • Contact information

Section 4: Incident Description

  • Describe in detail what happened, why the incident occurred, and other helpful information. You can also capture photos or videos of the incident to give proper context.

  • Incident description

Section 5: Details about the Injury

  • Description of the injury (what it is, which body parts are affected, etc.)

  • Photo of the injury

  • Severity of the injury

  • Was any first aid administered on the site?

  • What treatment was provided?

  • Who administered the treatment?

  • Was the victim taken to the hospital immediately?

  • Which hospital were they brought to?

  • What treatment was provided?

  • How long did they stay in the hospital?

Sign-off and Completion

  • Recommendations

  • Name and signature of incident reporter

  • Job title

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.