The RIDDOR Form Template UK is provided in multiple formats, including PDF, Word, and Google Docs, featuring editable and printable examples to suit your needs.
Riddor Form Template UK Editable – PrintableSample
RIDDOR Form Template UK 1. Incident Information 2. Type of Incident 3. Details of the Incident 4. Persons Involved 5. Witnesses 6. Health Effects 7. Actions Taken 8. Preventative Measures 9. Reporting 10. Signatures and Agreement 11. Declaration
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WORD
Examples
Date of Incident: [DD/MM/YYYY]
Time of Incident: [HH:MM]
Location: [Exact location of the incident]
Describe the nature of the incident, including how it occurred and the events leading up to it: [Detailed description of the incident].
Name: [Name of the injured party]
Position: [Position of the injured party]
Department: [Department of the injured party]
Contact Information: [Phone and email]
Nature of Injury: [Type of injury suffered by the injured party]
Extent of Injury: [Severity of the injury, e.g. minor, serious]
Medical Treatment Required: [Yes/No, specify if treated]
Name of Witness: [Name of witness]
Contact Information: [Phone and email of witness]
Witness Statement: [Summary of what the witness observed].
Describe any immediate actions taken following the incident, e.g. first aid administered, situation reported to management: [Details on actions taken].
Investigation Date: [DD/MM/YYYY]
Investigated By: [Name of the person conducting the investigation]
Investigation Findings: [Summary of findings related to the cause of the incident].
List the steps that will be taken to prevent similar incidents in the future: [Actions to be implemented].
[Signature of the person completing the form]
[Name and Position]
Date: [DD/MM/YYYY]
Date of Incident: [DD/MM/YYYY]
Time of Incident: [HH:MM]
Specific Location: [Where the incident took place]
Provide a comprehensive overview of what happened, including context and sequence of events: [In-depth description of incident].
Name: [Injured person’s name]
Job Title: [Job title of the injured person]
Department: [Department of the injured person]
Contact Info: [Phone number and email address]
Type of Injury: [Specify the injury]
Severity of Injury: [Specify whether the injury is minor, serious, etc.]
Treatment Required: [Specify details if treated, including where and by whom].
Witness Name: [Name of witness]
Witness Contact: [Witness phone and email]
Witness Testimony: [What the witness observed].
Outline the response to the incident, including who was notified and any immediate care provided: [Response actions taken].
Investigation Completion Date: [DD/MM/YYYY]
Conducted By: [Investigator’s name]
Findings: [Summary of investigation findings related to the root cause of the incident].
Detailed recommendations to avoid recurrence of incident: [List of preventive measures].
[Signature of the individual completing the form]
[Full Name and Position]
Date: [DD/MM/YYYY]
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