Health and safety incident report and record
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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

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 incident happened (include details of any specific room or area where the incident happened)[Insert]
      If not in the office, description of location, eg home worker’s house, remote worker’s location, etc[Insert]
      Did the incident affect a lone worker?[Insert]
      The Local Authority in which the incident occurred[Insert]
    1. 4

      About the incident

      Date of incident[Insert]
      Time of incident[Insert]
      The type of work being carried out at the time of the incident[Insert]
      Type of incidentInjury/work-related ill-health/dangerous occurrence/death/other
      Details of what happened[Insert]
      Details of how it

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