Accident / Incident Report Form V2 – Greg Dougherty

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

First Name: Joe

Last Name: Bloggs

Post Code HD63LU

Please indicate if Employee

Date of Incident: Saturday, April 30, 1994

Time of Incident 19:00

Where did the incident take place? Public

Details of Injury wdwqq

Was the person treated in hospital? Yes

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

Did you contact family? Office? Police? dwqdqwd

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

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 dwqdqwdqwd

Name of individual completing the form Greg Dougherty

Date Tuesday, April 30, 2024