ACCIDENT BOOK All Centura Companies

ACCIDENT BOOK

All Centura Companies

This form is to be used to record all accidents on site and in offices of Centura Group Companies

This form is NOT for RIDDOR reporting

This form meets the requirements of "The Social Security (Claims and Payments) Regulations 1979"

All information provided in this form is private and confidential and the data contained in this form will be held in accordance with the Company GDPR Policy

Business Unit / Company*

Select your business unit from this list

Select or enter value

Full name of injured person*

This field should provide the full name of the injured person

Address of injured person*

Use this field to provide the address of the injured person

Occupation of injured person*

Add the occupation of the injured person here

Date of accident*

Select the date of the accident from the date picker

Time of accident*

Select the time that the accident happened from the drop down list. (to the nearest 30 minutes)

Select or enter value

Contract or Office name where accident happened*

Provide the name of the contract or office where the accident happened

Place where accident happened*

Provide the exact location on site or office where the accident happened.

Examples: "In the kitchen" or "On the scaffold at Pier 9"

Cause and nature of injury*

In this field you should provide details of and cause of the injury if known

Severity*

Red

Yellow

Green

Details of person reporting the accident

If you are filling in this form on behalf of the unjured person, you should add your Name, Address and Occupation here

File Upload

You can upload up to 10 images or documents using this field

These can be very helpful when investigation an injury

Drag and drop files here or

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