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 Risk and Safety Manager.

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: