Report an Incident or Near Miss

Report Details

What are you reporting? *

Near miss = something dangerous that did not cause harm. Incident = something that caused harm or damage.

Please select a report type.

When did it happen? *

Please enter a valid date (not in the future, not more than 30 days ago).

What time? * Your best estimate is fine.

Please enter the time of the event.

Your badge number * The number on your badge (e.g. T045 or just 45)

A valid badge number is required.

Where did it happen? — Area * Choose the area where it happened, not your own team.

Please select an area.

Where did it happen? — Team * Which team or location within that area?

Please select a team.

Exact location (optional) Use a What3Words address if you know one for the spot.

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Near Miss Details

What did you see? * Describe the hazard or danger you noticed.

Please provide a description (at least 10 characters).

How could this be prevented? (optional)

Photos (optional, max 3) JPEG, PNG or HEIC. Max 10MB each.

Please check your photo uploads.

What Happened

Type of incident * Choose the option that best describes what happened.

Please select an incident type.

Please specify *

What was happening at the time? * Describe the activity that was taking place when the incident occurred.

Please describe the activity.

Were those involved being supervised? *

Yes

No

Supervising staff badge number (optional) e.g. T045 or just 45

Who Was Hurt?

Was anyone injured? *

Yes

No

Injured person's first name (optional if number provided)

Please enter the injured person's first name.

Injured person's last name (optional if number provided)

Please enter the injured person's last name.

Injured person is a: *

Treatment & Witnesses

External help called *

None

Ambulance

Hospital

Clinic

Other

Please select at least one option.

Witnesses (optional, max 5)

What Happened Next

What happened to the activity? * After the incident, did the activity carry on?

Stopped

Modified

Continued unchanged

Please select an option.

What changes were made?

Why do you think this happened? *

Please describe the suspected cause.

What contributed to this? * Select all that apply.

Equipment

Environment (Weather/Surrounding area)

Behaviour

Inadequate Supervision

Inadequate Training

PPE Not Used

Other

Please select at least one contributing factor.

Specify other factor

Was PPE in use? *

Yes

No

N/A

Was the PPE adequate?

Yes

No

Important: PPE should be quarantined and passed to senior staff for inspection.

What has already been done to make it safe? (optional)

What else should be done? (optional)

Is this a reportable incident? *

POR criteria: Serious injury requiring hospital treatment, fatality, safeguarding concerns, emergency services called, adverse publicity risk, significant safety breach.

Yes

No

Unsure

Please indicate whether this is a reportable incident.