Accident or near miss
This form is to be completed by Community Resilience North Somerset Volunteers as soon as possible after an accident or near miss in the course of their volunteer activity.
Is this an:
Date of Accident/Incident?
Time of Accident/Incident if known?
Where did the Accident/Incident happen?
Name of persons involved in the Accident/Incident?
Name of person reporting the Accident/Incident?
Names of any persons witnessing Accident/Incident?
Full account of the Accident/Incident - including what was in your view responsible for the incident
Was any person injured?
Who was injured and what injuries did they sustain?
Have any measures been taken or planned to prevent this incident happening in the future?
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