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Accident form

Required fields are marked with an asterisk (*).

Details of Person Injured

Injured name*
Contact Number

(If staff)

Job Title
Division

Details of Person Reporting Incident

Reporting name*
Division
Contact Number
Email address*

Details of Person giving first aid

First aider name:
Contact Number

About the Incident

Location of Incident
How did the incident happen
Nature/detail of injuries

If you have any concerns about your health or tetanus status, please seek medical advice.

Immediate action

(Choose one or more actions taken)

Date of incident
Time of incident