Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
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| # | Inspection Item | Status | Notes |
|---|---|---|---|
| Injured Person Details | |||
| 1 | Full name, date of birth, and gender recorded | ||
| 2 | Home address and contact details recorded | ||
| 3 | Employment status and job title documented | ||
| Incident Description | |||
| 4 | Clear description of what happened and sequence of events | ||
| 5 | Activity being performed at time of incident | ||
| 6 | Equipment, substances, or machinery involved identified | ||
| Location and Time | |||
| 7 | Exact location of incident recorded (site, area, room) | ||
| 8 | Date and time of incident documented | ||
| 9 | Environmental conditions noted (weather, lighting, floor) | ||
| Injury/Condition Details | |||
| 10 | Nature of injury or condition described | ||
| 11 | Body part(s) affected identified | ||
| 12 | First aid or medical treatment administered recorded | ||
| 13 | Hospital attendance or admission documented | ||
| Witness Details | |||
| 14 | Witness names and contact information collected | ||
| 15 | Witness statements obtained and signed | ||
| Investigation Findings | |||
| 16 | Immediate cause(s) of incident identified | ||
| 17 | Root cause(s) and contributing factors determined | ||
| 18 | Risk assessment reviewed and updated | ||
| 19 | Photographs and scene evidence collected | ||
| Corrective Actions | |||
| 20 | Immediate corrective actions taken and documented | ||
| 21 | Long-term preventive measures identified with owner and date | ||
| 22 | HSE notified within required timeframe (10 days for over-7-day incapacitation) | ||
I confirm that all items have been inspected/completed as indicated above. Any defects or concerns have been noted and reported.