Site safety template, free to use
Accident and incident report
Record of an accident, incident, near miss or dangerous occurrence, with immediate actions and RIDDOR consideration.
Print it blank and fill it in on site, or use it as the structure for your own version. No sign-up, no email, no watermark. A competent person must adapt and approve any document before it is used on a real project.
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Accident and incident report
Free template from thebuildingsafetyact.com. To be reviewed and approved by a competent person.
Event details
| Project / site: | Date and time of event: |
| Exact location: | Type: accident / near miss / dangerous occurrence / ill health: |
| Reported by: | Date reported: |
Person affected (if any)
| Name: | Company: |
| Occupation: | Age: |
| Nature of injury: | Body part affected: |
| Treatment given: | Taken to hospital?: |
What happened: sequence of events
Immediate causes
Underlying causes
Immediate actions taken
Corrective actions, owners and dates
| Action | Owner | Due date | Complete |
|---|---|---|---|
Reportable under RIDDOR?
| Item | Yes | N/A | Comment |
|---|---|---|---|
| Assessed against RIDDOR criteria | |||
| Reported to HSE (record date and reference) | |||
| Considered for mandatory occurrence reporting (higher-risk buildings) |
Sign-off
| Investigated by: | Signature: |
| Date: | Reviewed by: |
| Signature: | Date: |
Free template from thebuildingsafetyact.com. This is a starting template, not professional advice. It must be reviewed, amended and approved by a competent person for the specific task, site and conditions before use. The Building Safety Act site and AI Metric Ltd accept no liability for its use.