Introduction to Health and Safety at Work

Incident and accident investigation and reporting
127
Kind of Accident
Indicate what kind of accident led to the injury or condition (tick one box)
Contact with moving 
machinery or material 
being machined
1
Injured while handling 
lifting or carrying
5
Drowning or 
asphyxiation 
9
Contact with electricity 
or an electrical 
discharge
13
Struck by moving, 
fl ying, or falling 
object
2
Slip, trip or fall on 
same level
6
Exposure to or 
contact with 
harmful substance
10
Injured by an animal
14
Struck by moving 
vehicle
3
Fall from height 
indicate approx distance 
of fall.........m
7
Exposure to fi re
11
Violence, physically 
assaulted by a person
15
Struck against 
something fi xed or 
stationary
4
Trapped by something 
collapsing
8
Exposure to an 
explosion
12
Other kind of 
accident
16
Detail any machinery, chemicals, tools etc. involved
Accident fi rst reported to: 
Name 
Position & 
Dept 
First Aid/medical attention by: 
First Aider Name 
Dept 
Doctor 
Name 
Medical 
centre 
Hospital 
WITNESSES
Name 
Position & Dept 
Statement obtained (yes/no)
Attach all statements taken
yes/no
yes/no
yes/no
yes/no
For Offi ce use only
If relevant: 
Date reported to HSE/LA 
a) by telephone 
.../.../20
b) on form F2508 
.../.../20
Date reported to organization’s insurers .../.../20
W
ERE
 
THE
 R
ECOMMENDATIONS
 
EFFECTIVE
 ? YES/NO
I
F
 
NO
 
SAY
 
WHAT
 
ACTION
 
SHOULD
 
BE
 
TAKEN
.

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Introduction to Health and Safety at Work
128
 
Appendix 8.2 Information for insurance/compensation claims
Information for insurance/compensation 
purposes following accident or incident
Factual information needs to be collected where there 
is the likelihood of some form of claim either against 
the organization or by the organization (e.g. damage 
to equipment). This aspect should be considered as 
a second objective in accident investigation, the fi rst 
being to learn from the accident to reduce the possi-
bility of accidents occurring in the future.
Workplace Claims
➤
Accident book entry
➤
First aider report
➤
Surgery 
record
➤
Foreman/supervisor accident report
➤
Safety representatives accident report
➤
RIDDOR report to HSE
➤
Other communications between defendants and 
HSE
➤
Minutes of Health and Safety Committee meeting(s) 
where accident/matter considered
➤
Report to DSS
➤
Documents listed above relative to any previous 
accident/matter identifi ed by the claimant and 
relied upon as proof of negligence
➤
Earnings information where defendant is employer.
Documents produced to comply with requirements 
of the Management of Health and Safety at Work 
Regulations 1999
➤
Pre-accident Risk Assessment
➤
Post-accident 
Re-Assessment
➤
Accident Investigation Report prepared in imple-
menting the requirements; Health Surveillance 
Records in appropriate cases; Information provided 
to employees
➤
Documents relating to the employee’s health and 
safety training.