X Close Icon

Accident Record Form

This form is to record any accidents. Please contact us on 020 7709 8900 or admin@halfmoon.org.uk if you have any questions. 

Accident Report

Please submit a report as soon as is safe and possible to do so. What to report: incident, accident, near miss, First Aid treatment or health and safety concern. Please record as much factual detail as possible. Once submitted, the report will be reviewed by the H&S Manager or Safeguarding Leads within 24 hours. If you need immediate support, contact Half Moon on 020 7709 8900. For urgent assistance, dial 999 and ask for the relevant emergency service.

About the person who had the accident

Please fill in all relevant details.
Are they a participant
Consent
Address

About you

The person filling out this report.

About the accident

DD slash MM slash YYYY
Time it occured
:
Did they require any other additional treatment?
Clear Signature
DD slash MM slash YYYY
By ticking this I give my consent to my employer to disclose my personal information and details of the accident which appear on this from to safety representatives and representatives of employee safety for them to carry out the health and safety functions given to them by law.(Required)
Privacy Policy(Required)