RIDDOR report record

Form · Each reportable incident, and each over-3-day injury

The record RIDDOR 2013 requires of a reportable incident (and of an over-3-day injury): when and how it was reported, when and where it happened, who was involved and what happened, with the HSE reference. Kept at least 3 years.

Use it in Sitro: add it to a project and fill it on a phone, free for 14 days.

The law and guidance behind it

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR), Regulation 12 and Schedule 1

The questions

The report

Date reported to the HSE (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 10)
How it was reported (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 11)
HSE reference number
What it was

The event

Date and time of the event (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 5)
Where it happened (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 8)
Full name of the person injured or affected (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 6)
Were they at work? (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 7)
Their occupation, and their employer (or their status if not at work) (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 6)
The injury (or the disease, and the date it was diagnosed) (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 6)
A brief description of the circumstances in which it happened (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013, Schedule 1, Part 2, paragraph 9)

Sign-off

Recorded by
Date and time
Signature

A template to adapt to your site, not legal advice.