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Accident Reporting Form
Ill Health (work related) Reporting Form
Near Miss Reporting Form (Inc. Dangerous Occurrences)
Violence (Physical and Verbal Abuse) Reporting Form
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New
Incident Form
Please complete the case details below.
Reference
This will be generated automatically on submission.
Brief description of incident
*
Incident Date
*
February 2021
Mon
Tue
Wed
Thu
Fri
Sat
Sun
05
1
2
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06
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07
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21
08
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28
09
1
2
3
4
5
6
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10
8
9
10
11
12
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14
Today
Clear
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
OK
Cancel
Incident Time
*
Overall severity of incident
*
Please select...
Fatal
Major
Minor
Line Manager's E-mail Address
*
Access Token
*
SAVE AND CONTINUE
CANCEL