Accident and Incident Report Form

First Name

Last Name

Client Type

Phone/Mobile

First Name

Last Name

Job Title

Date / Time of Incident

What was the injury? (e.g. fracture, laceration)

What part of the body was injured?

Was the injury (tick the one box that applies)

Did the injured person (tick all the boxes that apply)

About the kind of accident

Describing what happened

Give us as much detail as you can.

Attach any photo, video or report (max 10 files and max file size 10mb)

Choose File

To be completed by the Authorised person only.

First Name

Last Name

Status

Reported to Funder or External

Dated description

Intech Centre - City & Guilds Functional Skills exams / tests