Work-related injury and accident reporting record

Enter the name of the maintained or academy primary or secondary school.

Select the status that applies to the school.

Use the school's local reference or case number, if one has been assigned.

Enter the date on which the injury or accident occurred.

Enter the time if known; otherwise record that it is unknown in the incident description.

State where the injury or accident occurred, including the relevant room, area or off-site location.

Select the category that best describes the person who was injured or involved.

Record the name in accordance with the school's information-handling arrangements.

Describe what happened, the injury or harm reported, and any relevant circumstances. Do not use this field to make the final reportability decision.

Record first aid, medical attention, safeguarding or other immediate actions taken, as relevant.

List witnesses and people notified, or state that there were none or that this is unknown.

Identify the employer or proprietor responsible for the school and this record.

Enter the name and role of the person preparing the record. Preparation may be delegated, but responsibility remains with the employer or proprietor.

Enter the name and role of the person responsible for reviewing the record and reportability decision.

Enter the date on which the record was reviewed.

Select the outcome reached by the responsible reviewer. Apply the relevant legal and organisational criteria before selecting an outcome.

Explain the facts and review considerations supporting the selected outcome. If the outcome is not yet determined or further information is required, state what remains outstanding.

Confirm only after the required incident information and review decision have been recorded.

• Tick when complete

Select this only when the outcome above is not to submit an external report. If an external report is required, leave this unchecked and complete the submission fields.

• Tick when complete

Complete only if the reportability review determined that an external report is required. Record the reporting body or route used.

Complete only if an external report has been submitted.

Complete only if the reporting route provided a reference number or confirmation.

Complete only if an external report has been submitted.

Record remedial actions, communication, monitoring, investigation, review of controls or other follow-up actions, including the person responsible and any target date.

Enter the target completion date where follow-up actions are required. Leave blank if no further action is required.

Select the status that applies at the time this form is completed.

Record closure information or explain what remains outstanding.