Incident Report Form

Please use this form to report all non safeguarding concerns, incidents, hazards, near misses or accidents. This could include health and safety issues, data protection concerns or breaches, damage to property or other.

For Safeguarding related concerns please follow our Safeguarding Policy and reporting systems.

Your name *

Email address *

Venue/activity/group the report concerns *

What type of incident are you reporting? *

Select the best fit description of the incident/situation.

Hazard (observation of something which may cause injury, ill health or damage)

Near miss (event which may have caused injury, ill-health or damage)

First aid incident (requiring on-site first aid)

Recordable incident (requiring off-site treatment, but unlikely to affect activities the next day)

Fatality or Lost Time incident (resulting in an injury or illness which prevents someone being able to carry out activities the next day)

Data protection incident

Other incident

Details of incident *

Please include date, time, as many details as possible and the names of any witnesses

Actions taken so far. *

Any recommendations?

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