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Safety

Accident & Near-Miss Report Form

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  • Date, time, and exact location of the incident (building, floor, area, specific machine or work station)
  • Type of incident: tick one: accident causing injury / dangerous occurrence / near miss / occupational ill-health
  • Full name, job title, employer, and contact details of the person involved (or person affected if a member of the public)
  • Nature and body location of any injury sustained, or a description of the potential harm in a near miss
  • Detailed account of what happened: the sequence of events leading up to, during, and immediately after the incident, in the person's own words where possible
  • Causal and contributory factors identified at the time: for example, environmental conditions, equipment state, task demands, or human factors
All checks done
Safety

Accident & Near-Miss Report Form

A contemporaneous written record of every accident, injury, or near miss, required by law and the foundation of any RIDDOR report to the HSE. Without it, you have no defence against a civil claim, no evidence for your insurer, and no way to demonstrate you investigated and acted: a gap an HSE inspector will treat as proof of a failed safety management system.

14 checksPDF + printReviewed August 2026
Built on published UK guidance Show sources

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (SI 2013/1471), Regulations 4, 5, 6, 7, and 12, and Schedule 1 Part 2; Health and Safety at Work etc. Act 1974, section 2(1); Management of Health and Safety at Work Regulations 1999 (SI 1999/3242), Regulation 5; Social Security Administration Act 1992 (accident book duty); Limitation Act 1980 (civil claims retention context)

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What’s on it

14 things to check.

Everything that matters, nothing that does not. Here is the full list, exactly as it appears on the template.

  • 1Date, time, and exact location of the incident (building, floor, area, specific machine or work station)
  • 2Type of incident: tick one: accident causing injury / dangerous occurrence / near miss / occupational ill-health
  • 3Full name, job title, employer, and contact details of the person involved (or person affected if a member of the public)
  • 4Nature and body location of any injury sustained, or a description of the potential harm in a near miss
  • 5Detailed account of what happened: the sequence of events leading up to, during, and immediately after the incident, in the person's own words where possible
  • 6Causal and contributory factors identified at the time: for example, environmental conditions, equipment state, task demands, or human factors
  • 7Immediate action taken: first aid given, area made safe, equipment isolated, emergency services called (state by whom and at what time)
  • 8Witnesses: full name, job title, and contact details of each person who saw the incident or arrived immediately after
  • 9RIDDOR assessment: state whether the incident is notifiable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (SI 2013/1471) and, if so, the category (specified injury, over-7-day incapacitation, dangerous occurrence, fatality)
  • 10RIDDOR submission details if applicable: date and time reported to HSE, method used (online portal or telephone for fatalities), and HSE reference number received
  • 11Corrective and preventive actions agreed: description of each action, the person responsible, and the target completion date
  • 12Follow-up review date: the date by which actions will be verified as complete and effectiveness confirmed
  • 13Completed by: full name, job title, signature, and date of the person completing this form
  • 14Reviewed and countersigned by: responsible person or line manager name, signature, and date

Good to know

Under RIDDOR 2013 Regulation 12, you must retain records of all reportable incidents for at least three years from the date the record was made. However, because the Limitation Act 1980 allows personal injury claims to be brought up to three years from the date the claimant became aware of their injury (which can be much later), the HSE and most insurers advise retaining accident records for a minimum of six years, and up to 21 years where the injured person was under 18 at the time.

Source: Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (SI 2013/1471), Regulations 4, 5, 6, 7, and 12, and Schedule 1 Part 2; Health and Safety at Work etc. Act 1974, section 2(1); Management of Health and Safety at Work Regulations 1999 (SI 1999/3242), Regulation 5; Social Security Administration Act 1992 (accident book duty); Limitation Act 1980 (civil claims retention context)

Good to know

Questions, answered

What is the Accident & Near-Miss Report Form?

A contemporaneous written record of every accident, injury, or near miss, required by law and the foundation of any RIDDOR report to the HSE. Without it, you have no defence against a civil claim, no evidence for your insurer, and no way to demonstrate you investigated and acted: a gap an HSE inspector will treat as proof of a failed safety management system.

Why does it matter?

Under RIDDOR 2013 Regulation 12, you must retain records of all reportable incidents for at least three years from the date the record was made. However, because the Limitation Act 1980 allows personal injury claims to be brought up to three years from the date the claimant became aware of their injury (which can be much later), the HSE and most insurers advise retaining accident records for a minimum of six years, and up to 21 years where the injured person was under 18 at the time.

How do I get it, and is it up to date?

The PDF downloads the moment you check out, prints sharp in black and white, and opens on any phone. It is reviewed for August 2026 and you get any future update free when the official guidance changes.

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