Accident/incident Report Form Page 3

What action was taken: Check all actions taken. If more than one, indicate which occurred 1st, 2nd, etc.

First Aid – administered by:

Medical help sought (What and where) :

Sent Home

Other agencies informed:

Social services

Police

RIDDOR

Continued Activity (no action taken)

Other: Please specify:

Other: please specify:

Names and contact numbers of witnesses:

Person Completing the Report:

Signed:

Print name:

Date:

Reviewed by Risk Manager:

Signed:

Print name:

Date:

Return form same day (or within 24 hours) of accidents/incident for employee, patron, or visitor to the Venues Management

Department.

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Parent category: Business