Burton and South Derbyshire College
incident report
27/05/2024 17:10:44

(All fields with a * must be completed.)

REPORT DETAILS

*Your name :
*Your department :
*Your role/title :
*Incident date :
*Incident time :
:
*Incident location :
*Incident type :  
*Incident Category Type :
No. of witnesses :
Witness names :
*Entities Informed :

PERSON AFFECTED

*Full name :
*Role :
Dept :
*Gender :
*Nature of Injury :

Other injury:
*Area(s) affected : (please click on the text links or area on the body map)
If the injury was to a different area please state :
*Action required :
*PPE correctly used? :
*First Aider called ? :
   *First Aider's Name :
*IF this person left the area : Destination :
Time departed
:
Affected person's address :

Affected person's phone number :

Parent / Carer / Next of kin contact :

(You can upload photos after submitting this report)


INCIDENT DESCRIPTION

*Describe the incident (in detail)

 

top of page     For questions / problems please contact : facilities.helpdesk@bsdc.ac.uk             © onlineaccidentbook.co.uk - Terms of Use