Report of a Dangerous Occurrence

Health and Safety at Work etc Act 1974
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013

This form is for duty-holders only to report defined Dangerous Occurrences under RIDDOR. It is not for making a complaint about or reporting a workplace issue. Advice for this is on the HSE website.

About you and your organisation

*Title

*Forename

*Family Name

*Job Title

Only 'responsible persons' including employers, the self-employed and people in control of work premises should submit reports under RIDDOR. If you are an employee (or representative) or a member of the public wishing to report a health and safety issues or an incident about which you have concerns, please refer to our advice. To ensure your concerns are directed to the correct place it is important that you report them via 'Tell us about a Health and Safety issue'

*Your Phone No

*Organisation Name

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

*E-Mail

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*Did the dangerous occurrence happen at the above address?

Yes No

About where the dangerous occurrence happened

*Where did the dangerous occurrence happen

Elsewhere in your organisation At someone else's premises In a public place (address known) In a public place (address unknown)

Organisation Name

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

Details of where the dangerous occurrence happened (if address is not known)

About the dangerous occurrence

*Dangerous occurrence date

*Dangerous occurrence time

In which local authority did the dangerous occurrence occur?

Please indicate the local authority area of the address where the dangerous occurrence happened. You need to select the Country first, then the geographical area (England only), and finally the local authority.
Selecting the local authority will help ensure that the appropriate Enforcing Authority (EA) for that area receives the notification.
For local authorities in England, each is allocated to a geographical area. The information is available on gov.uk 'Find your local council'

*Country

*Geographical Area

*Local Authority

In which department or where on the premises/site did the dangerous occurrence happen?

What type of work was being carried out (generally the main business activity on the site)?

Enter information on the industry to which the dangerous occurrence should be classified. In most cases this will involve classifying the main activity underway at the site where the dangerous occurrence happened.
The categories on this form are based on Standard Industrial Classification (SIC 2007). To see which detailed activities are available under each main industry, these are available in an Excel Spreadsheet .

*Main industry

*Main activity

*Sub activity

HSE LA

Type of dangerous occurrence

*Type of dangerous occurrence

Select a dangerous occurrence from either the general, mines or quarries lists

*Dangerous occurrence type specific to mines (if applicable)

*Dangerous occurrence type specific to quarries (if applicable)

*Describe what happened (HSE does not require any personal data to entered into this text box. Please consider what data you are inputting and ensure it does not contain any personal data before you submit the form).

Please provide further relevant information. For example:

further details about the operation or activity in progress

the environmental conditions

the name of any substances involved

the name and type of any machinery involved

the events that led to the dangerous occurrence

the part played by any people

action taken (if any) to prevent similar dangerous occurrences occurring.

Thank you for submitting your RIDDOR form

Your form has been received and has been assigned the Notification number . If you wish to keep a copy of the form, please download it using the button below. YOU WILL NOT RECEIVE ANY OTHER CONFIRMATION.

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