Health and safety incident report and record
Produced in partnership with DG Legal
Health and safety incident report and record

The following Practice Management precedent produced in partnership with DG Legal provides comprehensive and up to date legal information covering:

  • Health and safety incident report and record

    1. 1

      General

      Report compiled by[Insert name]
      Position of person compiling the report[Insert role]
      Date of report[Insert]
    1. 2

      Persons involved

      Name of person(s) injured (or whose health and safety was compromised)[Insert name of person injured or whose health and safety was compromised]
      Position or role of person(s) (where employed)[Insert]
      Status of person(s) (if not a person at work eg, client/customer, visitor, etc)[Insert]
      Gender of person(s)[Insert]
      Age of person(s)[Insert]
      Address of person(s) injured[Insert]
      Telephone number of person(s) injured[Insert]
      Name(s) of any witnesses to the incident[Insert]
      Address of any witnesses[Insert]
      Telephone number of any witnesses[Insert]
      Was the person affected a lone worker?[Insert]
    1. 3

      Incident location

      Address of office or other location in which the incident happened[Insert address of office or other location in which the incident happened]
      If in the office, department or part of the workplace in which the

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