Accident Report Form and Accident Book Entry template

2. Header details — complete for every entry

• Entry reference: [ref] | Date form completed: [date]
• Injured or affected person: [full name] | Contact details: [address / phone]
• Capacity: [employee / agency worker / contractor / self-employed working for us / visitor / customer or member of the public]
• Job title and department, if a worker: [job title], [department] | Length of service: [period]
• Date of the accident: [date] | Time: [hh:mm]
• Exact location: [precise place — "three metres inside the goods door", not "the yard"]
• What the person was doing at the time: [task, equipment in use, whether trained for it]
• Form completed by: [name, role] | Completed by the injured person themselves? [yes/no — if no, say why]
• Reported to: [duty manager name] at [hh:mm] on [date]
• First aid given by: [first aider name] — [yes/no] | Taken to hospital? [no / by ambulance / by own transport]
• Time off work expected or taken: [none / [number] days / unknown at time of writing — update this field, it drives the RIDDOR decision]
• Photographs, CCTV or other evidence secured: [what, by whom, held at [location]]

3. The accident record

One row per entry. Used as a bound or printed set, this grid is your accident book; used as a single sheet, it is the record for the incident named in the header block. Write what happened as a sequence of observable facts — what the person was doing, what changed, what they made contact with — and keep opinions out of it.

"Immediate action taken" is the column people leave blank and inspectors read first. It is the difference between a hazard that was made safe within minutes and one that was still there when the next person walked past.

4. Investigation: root cause and corrective action

Scale the investigation to what could have happened, not to what did. A near miss that could have killed someone deserves more attention than a cut finger, and a cut finger that is the fourth on the same machine deserves more than the first.

Every line below needs an owner and a date, and the "completed" column is what turns an investigation into a change. An action list with no completion dates is the single most common weakness in an accident file.

5. Getting to a root cause worth writing down

"Human error", "carelessness" and "employee failed to follow the procedure" are descriptions of the immediate cause, not root causes. They are also the reason files get closed with nothing changed: you cannot fit a corrective action to them beyond "reminded staff to be careful", which is not a control and will not survive the next wet Tuesday.

The test is simple. Read the root cause you have written and ask whether it names something {{org.name}} can change — a missing guard, an unrealistic task time, a procedure nobody was trained on, a check that was never scheduled. If it only names a person's state of mind, keep going. HSE's workbook Investigating accidents and incidents (HSG245) sets out the same progression from gathering information to identifying risk control measures and an action plan.

• Ask "what allowed that to happen?" of each answer until you reach something you can design out, guard, schedule or train.
• Separate the immediate cause (the wet floor), the underlying cause (no matting, no wet-weather check) and the root cause (housekeeping standards were never assigned to a role or a checklist).
• Check whether the relevant risk assessment anticipated this. If it did not, the assessment gets updated before the task resumes — record that here.
• Look for the same event in earlier entries. A pattern changes the action from "fix this" to "fix the system that produced this".
• Ask whether the procedure was realistic. A rule everyone breaks because the job cannot be done otherwise is a design problem, not a discipline problem.
• Where discipline genuinely is the right response, handle it separately under the disciplinary policy — it does not belong in the accident record.

6. RIDDOR decision block

Complete this block for every entry, including the ones that are obviously not reportable — the record of the decision is as useful as the decision. Check the HSE pages the day you decide; the categories are specific and change, and this block deliberately points at them rather than restating thresholds.

• Is it work-related? Did the work activity, the equipment, a substance or the condition of the premises cause or contribute to it? [yes / no — one line of reasoning]
• Who was affected: [worker / self-employed person working for us / member of the public, visitor, customer or patient]
• Category checked against the HSE lists today: [death / specified injury / over-seven-day incapacitation / non-worker taken directly from the scene to hospital for treatment / reportable occupational disease / dangerous occurrence / gas incident / none of these]
• Deadline that applies, per current HSE guidance: deaths, specified injuries and dangerous occurrences — notify without delay, report received within 10 days; over-seven-day incapacitation — report within 15 days of the accident; occupational disease — report as soon as the diagnosis is received. Confirm on the HSE page before relying on this line.
• Over-three-day incapacitation: HSE states this does not need reporting — record it here and in the accident book, and diary a check in case the absence passes seven days.
• Decision: [reportable / not reportable] — made by [name, role] on [date]. HSE guidance page checked: [page and date].
• If reported: submitted through the HSE online reporting service on [date] by [name]; HSE reference: [reference]; copy of the submission filed at [location].
• If not reportable: reason in one line — [reason].
• If in doubt, check or take advice the same day. The deadline runs from the accident, not from the day the argument was settled.

7. Sign-off

• Injured or affected person — statement given and read back: [name] — signature: [__________] — date: [date]
• Form completed by: [name, role] — signature: [__________] — date: [date]
• Checked by duty manager: [name, role] — signature: [__________] — date: [date]
• Investigation owner: [name, role] — investigation closed on [date]
• Responsible manager sign-off (RIDDOR decision and corrective actions): [name, role] — signature: [__________] — date: [date]
• Copy offered to the injured person: [yes/no] | Insurer notified: [yes/no — date, reference]
• Risk assessment updated as a result: [yes — [which assessment], updated [date] / no — reason]

8. Keeping the entry confidential

A completed entry names someone and describes their health, and GOV.UK confirms health information carries stronger legal protection than ordinary personal data. Treat the file accordingly: [locked cabinet / access-controlled folder], with access limited to [named roles], and audit who has it.

• Use detachable or individually sealed entries, or a system with per-record access — a bound book that everyone can leaf through exposes every previous injury to whoever is filling in today's.
• Never leave a completed form on a clipboard, a reception desk or a shared drive folder that the whole office can open.
• Share only what each recipient needs: a first aider needs the incident, the insurer needs the file, the team needs the lesson without the name.
• Redact names and identifying detail when you brief findings or publish trend figures.
• Log every disclosure to an insurer, solicitor, safety representative or enforcing authority: [who, what was shared, when, on what basis].
• Handle any request from the injured person for a copy of their own record under your subject access request procedure.

9. How long to keep accident records

RIDDOR regulation 12 requires an entry to be kept for at least three years from the date on which it was made, and regulation 25 of the Social Security (Claims and Payments) Regulations 1979 sets the same three-year minimum for accident book entries. Three years is a floor, not a target — personal injury claims and benefit questions can arrive later, so many employers keep accident records longer. Decide the period deliberately, record the reason, and align it with your data retention policy.

Some records have their own, longer regimes: where health surveillance is required under COSHH, regulation 11 requires the health record to be kept for at least 40 years from the date of the last entry made in it. Check the guidance for the specific regime rather than applying three years to everything.

Records connected with any ongoing claim, investigation or enforcement action are kept until the matter is closed regardless of the routine schedule. Retention: [period]. Owner: [name/role]. Held at: [system/location].

10. Review and trends

[Name/role] reviews all entries as a set at [frequency — monthly works for most sites], counting near misses alongside injuries, and reports the pattern to [meeting/owner]. The point of the review is to find the location, task or shift that keeps appearing, not to produce a total.

This form and the underlying accident and incident reporting procedure are reviewed [annually], after any RIDDOR-reportable event, and whenever the reporting route or the person making RIDDOR decisions changes. Owner: [name/role]. Next review due: [date].