Report | H&s First Ltd

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FIRST AID COMPLIANCE. MADE SIMPLE

You are required by law to report all accidents, incidents and near misses in the workplace.

Our systems rely on your input to ensure equipment is replenished quickly and company reporting is accurate.

Please complete the following form in as much detail as possible. This form should take 5-10 minutes.

Enter BOX NUMBER

What type of report would you like to complete? *

Accident

H+S Incident

Near Miss

Reporters name

Reporter Phone Number

Time of incident

Reporter position in the company

Reporter E-mail Address

Date of incident

Does the incident involve: (tick all appropriate)

Direct Employee

Member of the public

Contractor

Sub-contractor employee

Plant/Machinery/Property Damage

Near miss/ Dangerous occurence / other

Describe the incident in as much detail as possible.

Location of incident

Was First Aid Assistance required?

Yes

Did the injured party require further medical care? e.g. Ambulance, visit to hospital, GP referral

Yes

Details of injured party (If Appropriate)

Patient Full Name

Date of Birth

Patient Address

Employee Job Role (if applicable)

Part of Body injured

Details of relevant PPE worn at time of incident.

Please select all items that have been used in this incident.

All items will be automatically replaced according to the terms of your replenishment package.

Conforming Bandage

Eye Bandage

Finger Bandage

Washproof Plaster

Medium Sterile Bandage

Pair of Gloves

Triangular Bandage

Large Sterile Bandage

Eye Wash/Sterile Water pod

Hydrogel Burns Dressing

Adhesive tape full roll

Shears/Scissors

Cleansing Wipes

Foil Blanket

First Aid Box - case damaged

Resuscitation Face Shield

SUBMIT button below will be live once all mandatory fields are completed

Your report has been submitted

FIRSTAID.TEAM is a trading name of

H&S FIRST LTD - registered in England and Wales. Company Number: 15311180

VAT Number: 465 7530 74

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