Accident Report Form

RIDDOR 2013 Compliant Incident Recording

🏢 Company Details

Certain injuries, diseases and dangerous occurrences must be reported to the HSE under RIDDOR 2013. Over-7-day incapacitation, specified injuries, and fatalities are all reportable.
? Enter the full legal name of the company where the accident occurred. This is required for HSE reporting and record-keeping.
? Specify the site or office where the accident occurred. Include branch name, building number, or location identifier if applicable.

👤 Injured Person Details

Accident records must be kept for at least 3 years under the Social Security (Claims and Payments) Regulations 1979.
? Record the full legal name of the injured person. This is essential for identifying the individual in the accident report and HSE notifications.
? Record the injured person's date of birth. This helps identify if they are under 18 (young worker) and is needed for accurate HSE reporting and claims processing.
? Enter the job title or position of the injured person at the time of the accident. This helps determine if the work activity was relevant to the incident.
? Select the employment status of the injured person. Different categories have different reporting requirements under RIDDOR 2013 and HSE regulations.
? Record the department or team where the injured person works. This helps with assigning corrective actions and tracking trends by department.
? Record how long the injured person has worked for the company. New employees have higher accident rates and may need additional supervision or training.

📍 Accident Details

Record all accidents as soon as possible while details are fresh. Include witness statements where available.
? Enter the exact date when the accident occurred. This is critical for RIDDOR reporting timelines and determining if the 3-day or 7-day reportability thresholds are met.
? Record the time when the accident occurred as accurately as possible. This helps establish the timeline and may be relevant to shift patterns or working conditions.
? Specify the exact location within the workplace where the accident occurred. Be specific: building, floor, department, aisle number, or other identifying details to enable accurate site inspection if needed.

Be specific (building, floor, department, area)

? Provide a clear, detailed chronological account of the incident. Include what the person was doing, what went wrong, how the injury occurred, and any equipment or substances involved. HSE investigators rely on this information.
? Describe the specific work activity the injured person was performing when the accident occurred. Include details about tools, equipment, materials, or processes being used.
? List any other people directly involved in the accident, such as colleagues who may have contributed or been affected. Include their names, roles, and what they were doing.

🩹 Injury Details

? Select all injury types that apply. Different injury types are classified as "specified injuries" under RIDDOR 2013 and may affect reportability and legal compensation claims.

⚕️ First Aid Given

? Indicate whether first aid was administered to the injured person following the accident. Record all first aid treatment for medical and legal records.
? Record the name and qualifications of the person who provided first aid (e.g., qualified first aider, paramedic, nurse). This confirms proper care was given.
? Describe the specific first aid treatment provided (e.g., bandaging, ice application, CPR, recovery position). This creates a medical record of care given at the workplace.
? Indicate whether the injured person attended hospital for treatment. Non-worker taken to hospital is itself a RIDDOR reportable incident requiring HSE notification within 10 days.
? Record the name of the hospital or medical facility where the injured person was treated. This provides contact details for obtaining additional medical information if needed.
? Indicate whether emergency services (ambulance) were called. This indicates the severity of the incident and is important for HSE investigation and medical documentation.

📋 RIDDOR Reportable?

? Determine if this incident meets RIDDOR 2013 reporting criteria: death, specified injury, over-7-day incapacitation, non-worker to hospital, dangerous occurrence, or occupational disease. When in doubt, select "Unsure" and consult your safety manager.
? Select all applicable RIDDOR criteria that classify this incident as reportable. The HSE must be notified within 15 days for reportable incidents. This determines legal and insurance obligations.
? Record the date when the incident was reported to the Health and Safety Executive. RIDDOR requires notification within 15 days for reportable incidents. Failing to report is a serious offence.
? Record the unique reference number assigned by the HSE when the incident is reported. This enables tracking of the investigation and follow-up actions required.
? Record the name and title of the person who reported the incident to the HSE. This establishes responsibility and accountability for compliance with reporting obligations.

👥 Witnesses

? Indicate if anyone else saw the accident occur. Witness statements are valuable for investigations and help establish facts about how the incident happened.
? Record the full name of the first witness who saw the accident. This person can provide an independent account of what happened from their perspective.
? Record the witness's phone number or email address so they can be contacted for follow-up questions or to provide a formal statement if needed for HSE investigation.
? Record the witness's account of what they observed about the accident. Include what happened before, during, and after. Independent witness statements are crucial for accurate investigations.
? Record the full name of a second witness if available. Multiple independent accounts strengthen the investigation and provide corroborating evidence.
? Record contact details for the second witness. This allows the investigation team to reach them if additional information or clarification is needed.
? Record the second witness's account of the accident. Different perspectives help identify root causes and hidden factors that contributed to the incident.

🔍 Investigation

? Identify the direct cause of the injury (e.g., slip on wet floor, caught hand in machinery, trip over cable). This is the proximate event that led to the harm.
? Identify deeper root causes beyond the immediate trigger. Consider system failures, inadequate procedures, lack of training, faulty equipment, or environmental conditions that contributed to the accident.
? Analyse whether this accident was preventable and if so, how. Consider control measures, procedures, training, or equipment improvements that would have eliminated or reduced the risk.
? Summarise the immediate corrective actions taken in response to this accident. Include any temporary safety measures, process changes, or restrictions imposed until permanent solutions are implemented.

✓ Corrective Actions

? Describe the specific corrective action required to prevent this type of accident occurring again. Be clear and measurable so progress can be tracked and completion verified.
? Name the individual accountable for completing this corrective action. They should have the authority and resources to implement the action by the target date.
? Set a realistic deadline for completing the corrective action. This should be as soon as practicable depending on the severity and complexity of the action required.
? Record the actual date when the corrective action was completed. Leave blank until the action is fully implemented and verified. Compare against the target date to assess timeliness.
? Name the manager or supervisor who has verified that the corrective action was properly implemented and is effective. This provides oversight and accountability.

📅 Absence from Work

? Indicate if the injured person took time away from work as a result of this accident. Days of absence over 7 days are automatically reportable under RIDDOR 2013.
? Record the date when the injured person left work as a result of the accident. This is the start date for calculating absence and determining RIDDOR 7-day incapacitation reportability.
? Record the date when the injured person returned to full work duties. This determines the duration of absence and calculates total days lost. Later changes to this date may affect RIDDOR status.
? Record the total number of working days the employee was absent from work. Over 7 days (where the person would have worked) is a RIDDOR-reportable criterion and must be reported within 15 days.

✍️ Sign-Off

? The injured person acknowledges receipt of the accident report and confirms the details are accurate to the best of their knowledge. This is a legal record.
? Record the date when the injured person signed or acknowledged the accident report. Should be as soon as practicable after the incident.
? The line manager or supervisor responsible for the injured person signs to confirm they have received, reviewed, and accepted the accident report and investigation.
? Record the date when the reporting manager signed the accident report. This confirms management awareness and acceptance of the investigation findings.
? The Health & Safety Manager signs to confirm they have reviewed the investigation, verified the RIDDOR status, approved corrective actions, and confirmed HSE notification where required.
? Record the date when the H&S Manager completed their review and signed off on the accident investigation report and corrective actions plan.
? Confirm whether the full accident investigation is complete. Select "No" if further investigation is required before finalising the report. All reports should be completed within a reasonable timeframe.

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