Report of a Flammable Gas Incident

A report of a flammable gas incident will ask for the number of injured persons and their names. You will need this information to complete and submit this form.

About you and your organisation

*Title

*Forename

*Family Name

*Job Title

*Your Phone No

*Organisation Name

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

Fax Number

*E-Mail

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About the gas incident

*On what date did the incident happen?

*What was the main cause of the incident?

Exposure to carbon monoxide

Other exposure (e.g. to unburnt gas)

Fire or explosion

*Where did the incident happen?

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

In which local authority did the incident happen?

Please indicate the local authority area in which the site is located. 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

*Was it in a building?

Yes No

If yes, what type of building?

And in what room?

*Were the premises rented?

Yes No

What is the name of the person living in the premises?

*Title

*Forename

*Family Name

*Is the resident contactable?

Yes No

Details of the landlord or their managing agent

*Title

*Forename

*Family Name

Phone No

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

Contact details of someone other than the resident

*Title

*Forename

*Family Name

Phone No

*Address Line 1

Address Line 2

Address Line 3

*Town

County

*Post Code

About those injured as a result of the incident

*How many people died?

*How many people suffered major injury?

People injured as a result of the incident

*Title

*Forename

*Family Name

List of fatalities and injuries

*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:

the events that led to the incident

the part played by any people

action taken (if any) to prevent similar incidents occurring

Thank you for submitting your RIDDOR form

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