RIDDOR Report Template

Use this RIDDOR Report Template to document and report workplace incidents, ensuring compliance with reporting requirements and promoting safety protocols.

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Health & Safety
RIDDOR Report Template

Personal Information

Organization Details

Incident Details

Injured Person Details

Injury Details

Accident Details

Dangerous Occurrences

Other Details

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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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RIDDOR Report Template

Use this RIDDOR Report Template to document and report workplace incidents, ensuring compliance with reporting requirements and promoting safety protocols.

1. What is your full name?

2. What is your job title?

3. What is your telephone number?

1. What is the name of your organization?

2. What is its address and postcode?

3. What type of work does the organization do?

1. On what date did the incident happen?

2. At what time did the incident happen?

3. Where did the incident happen?

4. In which Directorate/Service or where on the premises/site did the incident occur?

1. What is their full name?

2. What is their home address and postcode?

3. What is their home phone number?

4. How old are they?

5. What is their gender?

6. What is their job title?

7. What is their employee ID number?

8. Was the injured person:

1. What was the injury?

2. What part of the body was injured?

3. Was the injury:

4. Did the injured person:

1. Kindly describes the accident

1. What is the number of dangerous occurrences you are reporting?

1. What is the main industry, activity, and work process?

2. What type of work was being carried out?

3. What substance was involved?

4. What type of machine was involved?

5. What were the events that led to the incident and the main factor that resulted in the incident?

6. What was the part played by the people?