incident or injury report form

Sorry to hear that you or a workmate have had an incident or injury whilst at work. We're here to help!

If you've not already contacted your consultant, please give them a call to advise of the situation and any associated details.

Alternatively, please complete the form below and your consultant will contact you as soon as they receive this form.

Your First Name

Your Last Name

Date of Incident or Injury

What is the name of the business and/or client?

Consultants Name

Is the client aware of this on-site incident or injury?

If yes, who did you tell?

Did an injury or incident occur?

What were you doing when the incident or accident happened?