Birmingham City Council financial challenges - time to Reset

To find out more about the budget and section 114 notice visit our budget information page

Accident, Incident and Near Miss Report

Important information

Part One of the form is to be completed by the employee who was involved in the accident, incident or near miss (or someone on their behalf such as their manager/supervisor).

Part Two should be completed by the manager / supervisor of the individual or establishment.  If the accident occurred to a member of the public / non-employee e.g. contractor, service user, visitor, the form should be completed by the site manager. 

Data Protection:  The intended use of the information contained in this form is to provide a preliminary investigation as to the cause and nature of the accident, incident or near miss and provide information to complete statutory returns, where applicalbe, to the HSE under the Reporting of Injuries, Diseases and Dangerous Occurrence Regulations (RIDDOR). 

rating button