Online Accident Reporting

Date of Incident *

Type of IncidentInjuryDamage OnlyNear Miss / Unsafe Condition

Nature of Incident, actions taken and by whom

Nature of injuries & any treatment givene.g. Bruising to ribs and minor cut to hand. Cut washed with fresh water and adhesive bandage applied. Rower to seek medical help if pain to ribs increases or doesn't diminish.

Name of Injured PersonThis will remain confidential and will only be used to ensure that are legal obligations are met.

Any damage to equipment or gig?YesNo

Please give details of damage.

Nature of Near Miss / Unsafe Condition observed

Name of Person Reporting Incident *

Email Address *

Phone *

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