Incidents, concerns or near misses
What is your full name?
What company are you working at? *
What sector do you work within? *
- Select - Rail Highways Construction Energy Aerospace Automotive Environment Maritime/Marine Life sciences Telecommunications IT Other
Who is your recruitment consultant?
What brand have you been engaged via?
- None - Gattaca Matchtech Networkers Resourcing Solutions Alderwood Barclay Meade
What is your email address?
Type of incident *
- Select - Injury sustained Illness (work related) Infectious diseases outbreak (excluding COVID-19) COVID-19 outbreak / concerns Dangerous occurrence Vehicle incident Security threat Suspicious behaviour/suspicious item Other
What is the name and email address of who this has been reported to? *
Please specify why this hasn’t been reported internally at the company that you are working for, where the incident took place. *
Where did the incident happen? *
Please provide names and contact details of any witnesses. (Please note that witnesses will need to provide their permission for you to complete this form with their details.) *
Was there an injury as a result of the incident? *
- Select - Yes No
Please detail where, and what type of injury was sustained. *
If the injury resulted in time off work when you would have otherwise been working still, please detail the dates from and to. *
Please detail any treatment provided at the time or soon after. *
Did the incident involve a vehicle? *
- Select - Yes No
Owned, company car, other (please specify) *
Submit
