• Accident & Reporting Form (CS2)

    Accident & Reporting Form (CS2)

    CORPORATE HEALTH AND SAFETY TEAM
  • Gender*
  • Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Incident Date*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Time of Incident*
  • Are you*
  • Pupil's Date of Birth*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Area of accident*
  • Full Name and Job Title of the person reporting the incident*
  • Nature of Injury (Please select most appropriate)*
  • Primary cause of Incident/Accident (Please select most appropriate)*
  • Secondary cause of incident/accident - What contributed to the accident/incident*
  • First Aid administered to Adult?*
  • Did affected person attended the Hospital or got treatment from paramedics?*
  • Date*
     - -
    2 digit day, 2 digit month, 4 digit year

  • OFFICE USE ONLY

  • In an emergency or serious injury inform Headteacher immediately

    • Premises Manager Section 
    • Was Premises Manager notified?
    • Risk Assessment completed by Premises Manager?
    • Date
       - -
      2 digit day, 2 digit month, 4 digit year
    • RIDDOR Reporting  

    • RIDDOR CLASSIFICATION:

      These classify/confirms if the injury is subject to RIDDOR legislation and such will need to be reported to the Health & Safety Executive. There is no requirement to check that the hospital actually gave the treatment. The requirement to report is based on the pupil/person taken to the hospital for treatment of an injury. if an injury identified at the scene is requiring hospital treatment, this should be reported. If no injury is evident and the school receives no information that any injury has been treated, no report is required. 

      See RIDDOR guidance HERE:

      - RIDDOR - Dangerous Occurrence

      - RIDDOR - Fatality

      - RIDDOR - Major injury or condition 

      - RIDDOR - Member of the public taken to hospital

      - RIDDOR - Staff absence over 7 days 

      - RIDDOR - Pupil taken straight to hospital received treatment

      - RIDDOR - Reportable occupational disease or condition of staff

      - Not RIDDOR - Examination shows no injury

    • Any injury at the scene that requires treatment is a reportable RIDDOR, is this accident/incident is a RIDDOR
    • Please select the appropriate if this incident is RIDDOR?

    • Click here to report the RIDDOR. 

    • Have you reported this incident to the HSE?
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Date of Submission*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Was time lost due to staff absence?
    • Staff first day absence*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Staff last day absence*
       - -
      2 digit day, 2 digit month, 4 digit year
    • Investigator Section 
    • Was it investigated?
    • Who investigated it?*
    • Date*
       - -
      2 digit day, 2 digit month, 4 digit year
    •  
    • Should be Empty: