Accident Report Form

Accident/Incident Report Form

Please complete this form to report any accident or incident within a student group activity. All information is collected and stored securely and confidentially with the Students' Union Health and Safety Department
Accident or Near-Miss?

An Accident Is an unplanned occurrence that has caused either injury to a person, damage to equipment/property or both. A Near-Miss is an unplanned occurrence that has not injured anyone or damaged anything this time, but may do in the future.
What are you reporting?*
An accident is where harm occurred to a person or damage to property. A near miss is where an incident could have happened, but didn't due to time or distance.
Student Group Type*
If your group type is not shown, scroll to the end and select 'other' and enter the name of your group
Sports Club*
If your group is not shown, scroll to the end and select 'other'
Society*
If your group is not shown, scroll to the end and select 'other'
Hall Committee*
If your group is not shown, scroll to the end and select 'other'
SB Group*
If your group is not shown, scroll to the end and select 'other'
Campaigning Group*
If your group is not shown, scroll to the end and select 'other'
Karnival Team*
If your group is not shown, scroll to the end and select 'other'
MedSoc Group*
If your group is not shown, scroll to the end and select 'other'
Intra-Mural Sport*
If your group is not shown, scroll to the end and select 'other'
Derby Group*
If your group is not shown, scroll to the end and select 'other'
Volunteering Project*
If your group is not shown, scroll to the end and select 'other'
Media/Service Group*
If your group is not shown, scroll to the end and select 'other'
Networks*
If your group is not shown, scroll to the end and select 'other'
Other (Please Specify)*

Does the Accident Need Reporting to University?

YesNo
Does The Incident need further investigation?

YesNo
Upload Accident Investigation Form (if Needed)

Upload a File

Cancelof
any further details for office use from investigation
Email
example@example.com
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Accident/Incident Report Form

Accident or Near-Miss?

About the Person Who Had the Accident

About the Injury Accident

About the Damage Accident

About the Near-Miss

Witnesses

About the person filling in the form

First Aid Kit - Equipment Used