Accident report

Accident report: staff, contractors or visiting adults

This form is for injuries to employees, contractors or visitors. Accidents to pupils should be reported at https://www.kes.org.uk/accident. A printed copy of this form is available if you are unable to complete it online.
About the person who had the accident
Name*

PrefixFirst NameLast Name
Gender*

MaleFemale
Address*

Street Address Line 1

Street Address Line 2

CityCounty

Post Code
Day-time phone number*
Email
example@example.com
Occupation*
Are you a*

School employeeContractorVisitor
Who is your employer?
What work were you doing on site today?
Is the person filling in this form, the same as the person who was injured*

YesNo

About the accident
When did the accident happen?*
Where did the accident happen?*
How did the accident happen?*
What were the injuries?*
Was any first aid provided on our site?*

YesNo
Who was the first aider?
What first aid was provided?
Did the casualty have to miss any days of work as a result of the accident?*

YesNo
How many days of work were or will be missed
Approximately
Did anyone witness what happened?*

YesNo
Name of witness

PrefixFirst NameLast Name
Email address of witness
example@example.com
Phone number of witness
Is there anything the school might do to make this accident less likely?*

YesNo
What can the school do?*
We are required by law to keep a record of accidents, and to report certain types of accident to the Health and Safety Executive.

However, you may decide whether your data may be passed on to third parties, for example representatives from your union, or safety consultants engaged by the school. In the event that the school wishes to share your data with such parties, we will seek your consent to do so.
Should be Empty:

About the person who had the accident