Incident Reporting Form Template UK

The Incident Reporting Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, and features both editable and printable versions for your convenience.

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Sample

Incident Reporting Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Incident Reporting Form Template UK

1. Incident Details


2. Reporter Information


3. Incident Description

4. Witness Information

5. Injuries or Damages

6. Immediate Actions Taken

7. Follow-Up Actions Required

8. Notifications

9. Additional Comments

10. Declaration and Confirmations


PDF

WORD

Examples

Incident Reporting Form Template UK (1)
Date of Incident:
[Insert Date]
Time of Incident:
[Insert Time]
Location of Incident:
[Specify Location]
Reported By:
[Name of the Reporter]
[Reporter’s ID]
[Reporter’s Contact Information]
Type of Incident:
[e.g., Accident, Near Miss, Hazard Identification]
Details of the Incident:
[Provide a detailed description of the incident, including what happened, how it happened, and any immediate actions taken.]
Witnesses:
[Names and Contact Information of any witnesses]
Injuries Sustained:
[Details of any injuries, if applicable]
Immediate Actions Taken:
[Describe any immediate measures taken to address the incident, such as first aid administered or evacuation procedures followed.]
Follow-up Actions Recommended:
[Outline any recommended actions to prevent future incidents, such as training or policy changes.]
Signed By:
[Signature of the Reporter]
[Date of Signature]
Incident Reporting Form Template UK (2)
Date of Incident:
[Insert Date]
Time of Incident:
[Insert Time]
Location of Incident:
[Specify Location]
Reported By:
[Name of the Reporter]
[Reporter’s ID]
[Reporter’s Contact Information]
Incident Classification:
[e.g., Safety Incident, Security Incident, Environmental Incident]
Incident Summary:
[Provide a thorough summary of the incident detailing all pertinent facts including the sequence of events and any equipment or materials involved.]
Persons Involved:
[Names and Contact Information of all individuals involved in the incident]
Injuries Reported:
[Detailed description of any injuries that occurred, including the severity and location of injuries.]
Actions Taken Post-Incident:
[Outline actions taken after the incident to mitigate further risk, such as reporting to authorities or initiating safety reviews.]
Preventive Measures Suggested:
[List suggestions for preventing similar incidents in the future, including upgrades, training, policy reviews, etc.]
Signature of Reporter:
[Signature of the Reporter]
[Date of Signature]

Printable

PDF – 1 PDF – 2

Incident Reporting Form Template UK