TWB | Incident Report

Name of person incident relates too?

Staff / Customer?

Date/Time of incident

Location of incident?

Please describe what happened?

Did this incident result in injury?

If yes please describe the nature of the injury?

Was emergency services called?

What time were they called?

Did emergency services attend?

If emergency services attend what time did they arrive?

Do you feel the incident was handled correctly?

Is there any further action required?

If yes, please highlight next steps

Are there any measures we could implement to avoid this in the future?

Is there any further training required to assist in situations like this in the future?

If this incident relates to a non-staff member, please fill in their contact details below:

Contact Number?

Email Address?

Address if given?

Name of staff member reporting?

Follow up reporting:

OFFICE USE ONLY

Date followed up?

Follow up report:

Name of management following up?