Health and safety report of injury or dangerous occurence

This form is part of legislation known as RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations Act, 2013).

It must be completed by the manager, officer in charge, head teacher or supervisor of the location, establishment or work activity.

There are several parts to the form, and you will be required to give detailed information about the incident and the injured person. Please note - if you have a report of multiple people being injured, you will have to complete a form for each person.

The fields marked with an asterisk (*) are required fields. All the information you enter will be submitted securely.

Part 1 of 6 - About You

* Full name:
* Job Title:
* Your responsibility:

* Work telephone number:
Email address
Confirm Email address
* Departmental address and postcode:
* Did the incident happen at this address?

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