RIDDOR Compliant Incident Report Form

Comprehensive incident report form meeting RIDDOR requirements for reportable accidents and dangerous occurrences.

Report Reference Number *

Date of Incident *

Time of Incident *

Site Location *

Exact Location (specific area) *

Type of Incident *

Injured Person's Name (if applicable)

Injured Person's Role

Employer Details (if not Eddie's DD)

Dog(s) Involved (name and owner)

Full Description of Incident *

Description of Injury/Damage

Body Part(s) Affected

Immediate Action Taken *

First Aid Administered?

First Aid Details

First Aider Name

Medical Attention Required?

Hospital Name (if applicable)

Time Off Work Required?

Witness Names and Contact Details

Root Cause Analysis

Contributing Factors

Equipment failureEnvironmental conditionsInadequate trainingProcedure not followedProcedure inadequateSupervision issueCommunication failureHuman errorAnimal behaviourThird party actionsUnknown

Corrective Actions Taken/Planned *

Corrective Action Owner

Action Completion Deadline

Is This RIDDOR Reportable? *

RIDDOR Report Reference (if submitted)

Date Reported to RIDDOR

Owner Notified?

Insurance Company Notified?

Photos/Evidence Attached?

Additional Notes

Report Completed By *

Date Report Completed *

Reporter Signature *

Sign here (or print and sign by hand)

Manager Review Comments

Manager Signature *

Sign here (or print and sign by hand)

Manager Review Date

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