Incident Report Form

This form is to be completed by MS Society employees and volunteers where there is an incident but no one is injured. By reporting at this stage, it may be possible to stop someone being seriously injured in the future.
Please note if an injury has occurred it must be reported on the accident report form.

If an employee, please provide their department and building

If a volunteer, please provide their group name

If an employee, please provide the department and building

If a volunteer, please provide the group name

Please provide full name, full postal address and contact numbers of any witnesses available.

Data provided in this form will be used to review the incident and will be stored in line with the MS Society data retention schedule. The information will be shared with the Health and Safety Executive when required by law.

Please tick the box below and input your email address to receive a copy of the completed form. This should be shared with the person involved in the incident and should then be deleted.

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