Accident / Incident Form – Greg Dougherty

Section 1: Information about person involved in the accident / incident

First Name: e2e

Last Name: e12e

Post Code e21e

Please indicate if Employee

Where did the incident take place? Public

Details of Injury e12e

Was the person treated in hospital? Yes

If yes, which hospital? e12

What happened? How did it happen? What did you do? e12e

Did you contact family? Office? Police? e12e

Has the incident been reported to the Police and/or Council? Yes

Please Provide details Please provide name, contact number, email and titlee21e

Has the accident been classes as "reportable" as required by RIDDOR regulation? Yes

Has NOK been informed? Yes

Actions to be take? Provide additional training

Additional Information e21e

Name of individual completing the form Greg Dougherty

Date Friday, October 4, 2024