Accident Book

On Line Accident reporting.

Please use this form to report all injuries, accidents or near misses.

Minor incident – This is defined as an incident that has a physical injury, which is dealt with by the designated on-site First Aider. Any treatment administered is from the on-site HSE Standard First Aid Kit.

Major incident – This is defined as an incident that has a physical injury where the injury is dealt with by a professional health care worker. This may be at the scene of the incident or at a point later if the injury was not identified at the time of the incident.

Serious incident – This is defined as an incident that has a physical injury where the injury is dealt in a hospital and is normally after an ambulance attended the scene of the incident.

2. What date did it happen on? This question requires a valid date format of DD/MM/YYYY.

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3. What time did it happen?

5. Where did it Happen?

6. What Happened?

9. What were the weather conditions?

10. What were the road conditions?

11. Where the Police called?

12. Officers details

12. Phone Number

12. Crime Number

12. Action Taken

12. Name and address of person involved.

13. If any injuries, please state them below.

14. What treatment was provided?

15. Name of the person completing this form.

16. Is the person reporting this incident also the instructor at the time?

17. Instructors Name

17. email address of the person completing this form This question requires a valid email address.

18. Was this form completed in the presence of the injured person

19. Does the injured person agree to the contents of this accident report?

20. Is there any corrective action that could be taken to prevent this type of incident occurring again?