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 University 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

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: