Accident / Incident Form – Greg Dougherty

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

First Name: Gregory

Last Name: Dougherty

Post Code HD63LU

Please indicate if Other

Please indicate if (Other) Other

Date of Incident: Friday, August 19, 1994

Time of Incident 17:00

Where did the incident take place? Other

Where did the incident take place? (Other) Park

Details of Injury Fell

Was the person treated in hospital? Yes

If yes, which hospital? Huddersfield

What happened? How did it happen? What did you do? Fell on the path

Did you contact family? Office? Police? Family

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

Please Provide details Please provide name, contact number, email and title...

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

Has NOK been informed? Yes

Actions to be take? Other

Actions to be take? (Other) Other

Additional Information Hello!

Name of individual completing the form Greg Dougherty

Date Friday, October 4, 2024