Report an Injury or Dangerous Occurrence

This form must be filled in by an employer or other responsible person.
If more than one person was injured as a result of an accident, please complete a separate form for each person.

This form can be used to notify an Injury or Dangerous Occurrence covered by the:

  • Health and Safety at Work etc Act 1974 (as applied to the Island)
  • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (as applied to the Island).

Unless specified, all fields must be completed.

  1. Introduction
  2. Your Details
  3. Incident Details
  4. Injured Person
  5. The Injury
  6. What Happened
  7. Declaration

Introduction

Introduction