Meta Data

Reporter Details

The information in this section starts with to you, the person filling in this form. We require the name of the Manager of any person injured or affected or the senior person in charge who will take ownershop of this incident. It also includes the Directorate, Division and Department within Camden that this incident should be assigned to.

Press Enter After Each Email Address

Corporate Structure

Location Details

This page allows you to confirm whether the incident occurred at the location you have selected on the previous page or if it has happeneded somewhere else. e.g. You may have selected 'Holmes Road Depot' on the previous page (shown below) but the incident may have occurred at a residents property. You may have selected a School in the previous section but the incident occurred during a school trip. Select 'No' to the question 'Did the Incident Occur At The Address Above?' to provide the address of where the incident occurred.

Reporters Address

If the Address Fields below are blank, it means the 'Location Search' on the previous page hasn't worked. Please enter the address manually.

Did The Incident Occur At The Address Shown Above?

Incident Details

This section allows you to confirm exactly when the incident took place and also explain what happened during the incident. Try to be as detailed as possible e.g. what work activity was the person involved in the incident carrying out, what happened to cause any harm and what happened aterwards.

Incident Details - Part 2.

The information in this section relates to you, the person filling in this form and not the person who completed the paper copy accident form.

Has The Incident Been Captured By CCTV?
Is This A Sports/ Playground Incident?
Was The Incident Aggravated In Any Way e.g Use Of A Weapon, Drugs, Alcohol, Mental Health etc.
Describe the Environmental Conditions at the time.

People Involved

This section allows you to capture the names of All Involved along with their involvement in the incident. The number of questions is dynamic and will grown or shrink based on your responses. At least 1p person's details are required in order to moved beyond this section

ID Name Involvement Status

Submission Page

Almost There...

You have reached the end of the report and can now submit your information using the button below. Make a note of the reference number below.

Once submitted, the information you have provided will be emailed to:

  • You, as the Reporter of this incident.
  • The Line Manager of the person involved.
  • The Corporate Health and Safety Team.
  • Any Addtional Email Recipient you have included.

THIS IS WHERE THE REFERENCE WILL APPEAR

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