IMPERIAL COACHES LTD

Accident Report Form

RIDDOR - Reporting to HSE via the Incident Control Centre (ICC)

Death or major injury - As soon as possible by telephone and report via website or post within 10 days.
Over seven day injury - Report with 15 days.
Dangerous Occurrence - Even if no injury is reportable, an occurrence that may have resulted in injury should be reported as soon as possible, followed by written report within 10 days via website or postal form.

ICC details:
Telephone - 0845 300 9923
Fax - 0845 300 9924
Internet reports - www.riddor.gov.uk
Email - riddor@natbrit.com

About the accident

I am reporting a

Loss of time/injury
First aid incident
Close call
Observation

Person Reporting Incident *

First

Last

Person Involved in Incident *

First

Last

When did it happen? *

What time did it happen? *

Where did it happen? *

Please describe the event in detail. *

Give details of any injury suffered and treatment given. *

If none state "none"

Was damage done to any of the property?

Could this incident been avoided?

Phone