The Work Place Injury Report Form is a crucial document required under English and Welsh law for recording and reporting workplace accidents and injuries. It is designed to comply with RIDDOR 2013 requirements and the Health and Safety at Work Act 1974. Organizations must complete this form when workplace incidents occur, capturing detailed information about the injury, circumstances, and response measures. The form serves multiple purposes: meeting legal reporting obligations, supporting internal investigation processes, and providing documentation for potential insurance or legal proceedings. It should be completed as soon as practically possible after an incident occurs.
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1. Employee Information: Personal details of injured person including name, job title, employee ID, department, and contact information
2. Incident Details: Date, time, location, and nature of injury/incident, including specific workplace area and circumstances
3. Injury Description: Detailed description of the injury including type, severity, body part affected, and immediate symptoms
4. Witness Information: Names and contact details of any witnesses to the incident, including their role and relationship to the incident
5. Initial Response: Details of first aid administered, personnel involved in response, and immediate actions taken following the incident
1. Equipment Involved: Details of any machinery, tools, or equipment involved in the incident, including serial numbers and maintenance records
2. Environmental Factors: Description of environmental conditions that may have contributed to the incident, including weather, lighting, or workplace conditions
3. PPE Information: Details of Personal Protective Equipment in use at the time of incident, including condition and appropriateness
4. Third Party Involvement: Information about any contractors, visitors, or third parties involved in or affected by the incident
1. Medical Report: Detailed medical assessment and treatment records from qualified healthcare professionals
2. Risk Assessment: Copy of relevant risk assessments for the task or area where incident occurred
3. Training Records: Documentation of relevant safety training and certifications completed by the injured person
4. Incident Scene Documentation: Photographs, diagrams, or sketches of the incident scene and any relevant equipment or materials
5. RIDDOR Report: Copy of the RIDDOR report if the incident meets reporting requirements
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