Accident and Near-Miss Report Form
This form must be completed immediately after the incident by the responsible person or the injured person if they are able to do so. First aiders and Security should complete the form if they attend.
Near misses and dangerous occurrences can be reported by whoever witnesses the incident or when they first become aware.
If an accident or near-miss takes place at your activity or event and you do not report it, your group may be subject to disciplinary action.
Section 1: About the Incident
Details of the Incident:
Please provide us with details about the incident.
Type of Incident:
Date of Incident: (dd/mm/yy)
Time of Incident: (hh:mm)
Did the accident take place on campus?:
Exact location of incident:
Description of incident (please provide as much information as possible):
Was anyone injured?:
If yes, please provide details:
What happened after the incident?:
Section 2: About the person involved in the Incident
You can report the incident for yourself or on someone else's behalf. If you are completing the form for yourself please complete your details, otherwise select who you are reporting the incident for and enter their details.
Who are you reporting the incident for?:
SID (if an ARU student:
Is the person involved in the incident under 18?:
Section 3: Witnesses
Witnesses can help us get a better understanding of an incident. Enter the details of any witness/s to the incident and we will contact them if required. There's no limit to the number of witnesses you may add though generally 1 or 2 is sufficient.
Was there a witness present?:
Do you have contact details for the witness(es)?:
If yes, we may be in touch to request these details.
Before you submit this form:
Please ensure the details you have provided are factual and accurate. Once the form has been submitted changes can only be made by contacting ARU Students' Union.
If you require this form in a different format or if you have any queries about this form, please contact firstname.lastname@example.org.