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Name
Location
Phone No
Time of Incident
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Email
Date of Incident
Employer
Please check the box that describe the situation.
Safety*
Buried Services
Collapsed Excavation
Fall from a Height
Hand Tools Powered
Hand Tools Manual
Harmful Substance
Hit Something Fixed/Stationary
Moving Machinery
Moving Vehicle
Manual Handling
Welfare
Hand Tools Powered
Site / Office Security
Slipped Tripped Fell at Same Level
Something Collapsing/Overturning
Lifting Operations
Overhead Services
PPE Non Compliance
Environment*
Discharge To Water / Sewer
Electricity
Explosion
Live Traffic
Fuel / Chemical Spill or Leak
Extreme Weather
Waste Storage / Disposal
Fumes / Odours / Dust
Carbon Emission
Nature of Incident
Brief Description of Good Practice
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