Accident/incident Report Form
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5ACCIDENT / INCIDENT REPORT FORM
(This form is to be completed for all volunteers, service users and visitor accidents /incidents)
Please fill in the churches accident form separately to this form and hand it into the office.
All accidents/incidents to be reported. Wittiness statements to be taken/written where appropriate.
Management is required to complete Section III, review the report for completeness and accuracy, sign and log this
report in the accident/incident log book within 24 hours of the accident/incident. Note: the report (and pictures if
any) should then be filed together in a safe and secure location. Any copies of this report and any other related
materials in conjunction with this report cannot be obtained without the authorization of management.
Preserve evidence.
Do a body map where appropriate.
Record all information as soon as possible.
Record what the circumstances in which the accident/incident came
Use black pen.
about.
Keep writing clear and legible.
Note the setting and anyone else who was there at the time, and
Do not use jargon or abbreviate.
record this using their own words/phrases.
Do not record your own opinion if you are filling the form in on behalf of
Do not touch anything that may be evidence.
another person.
If the incident was witnessed then the witness needs to do a
Use fact and the individuals own words, expressions, appearance, behaviour
witness statement and write down exactly what was seen.
and views.
SECTION I
PLEASE PRINT OR TYPE ALL INFORMATION
Name:
TELEPHONE NUMBER:
Address:
Mobile phone number:
Date of birth
Age:
(why were you visiting?)
Postcode:
Volunteer
Service user
Trustee
Visitor
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