Accident Book

Untitled Document

Please fill out this form to the best of your knowledge.
The results of the report will be sent to the College Health and Safety Officer - Andrew Thompson

About the person who had the accident/near miss





Address (of person experiencing accident/near-miss):





About the person filling in this form - repeat if necessary




Address (of person filling out form):





Details about the accident/near-miss





Location:
Blenheim Walk
Vernon Street
Rossington Street
Office Building
Other (Please specify)






Incident details:
Please specify in as much details as possible: Please give details of the cause if known: Please give details of the injury: