RIDDOR Incident Assessment and Notification Record

Enter the legal or commonly used name of the school.

Enter the school's internal incident or accident reference.

Enter the date on which the incident occurred.

Use the school's standard time format. If the exact time is unknown, record the best available estimate.

State where the incident occurred, including the off-site location or activity venue where relevant.

Provide a factual description of the incident, including the activity taking place, equipment or substances involved, and immediate circumstances.

Select all categories that apply.

Record the name or a secure internal identifier in accordance with the school's information-governance arrangements.

Select the option that best describes whether the incident arose out of or in connection with a school work activity or an activity organised by the school.

Describe the work activity, lesson, trip, event, supervision arrangement or other organised activity connected with the incident. Complete where applicable.

Select all outcomes that apply.

Describe the injury or ill health, including the body part affected and apparent severity. Complete where applicable.

Select yes only where the person was taken directly from the scene for treatment. Examinations and diagnostic tests alone do not constitute treatment. Complete where applicable.

Record the hospital, date of attendance and treatment information available to the school. Complete where applicable.

Describe the event and the circumstances supporting the dangerous-occurrence assessment. Complete where applicable.

Select all factors that may have contributed to the incident.

Record the current assessment. If the decision is uncertain, seek further advice before closing the assessment.

Explain how the incident facts, work-activity connection and outcome support the assessment decision. State any uncertainty or information still required.

Enter the name of the person who made or reviewed the assessment.

Enter the person's role or job title.

Enter the date on which this assessment was completed or last reviewed.

Complete where the incident has been notified to HSE.

Enter the HSE notification reference, confirmation number or other evidence of notification. Complete where applicable.

Tick this box only after the notification reference or confirmation has been checked against the school's records. Complete where applicable.

• Tick when complete

Record any immediate controls, investigation, communication, review or corrective actions arising from the incident.

Enter the date by which this record or any follow-up actions should next be reviewed. Complete where a further review is needed.