Staff Accident Report

This form must be submitted whenever there is an accident. WE value our staff and clients and we carefully review all incidents so we can ensure the Health and Safety of all.

Please remember to press the Submit button so that we receive the file.

Date of Occurrence*
MM slash DD slash YYYY
Name of Staff Member*
First Last
Email address of Line Manager*
Where did the accident happen?*
Customer Site Details*
Site Contact*
First Last
Site Contact email*
Copy of site accident report to be uploaded here (if applicable)
Max. file size: 256 MB.
Description of occurrence*
What caused the accident?*
Would better H & S Training have prevented the accident?*
- Yes
- No
Was a hospital visit required?*
- Yes
- No
Start Date of Sick Leave (if applicable)
MM slash DD slash YYYY
End Date of Sick Leave (if applicable)
MM slash DD slash YYYY
Number of work days lost as a result of the accident

01684 561002

[email protected]

01684 561002

[email protected]

Staff Accident Report

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Quality Assurance