(DJH Oct 09)

Procedure No. 2 - UVH Accident/Incident Report Form

A member of the Management Committee must be informed and the following form filled in for

-any accident involving personal injury no matter how small, which occurs in the Hall or its surrounds (car park, garden etc)

-any failure of equipment belonging to the Village Hall or brought in by a Hirer

-any near-miss where it is judged that personal injury or equipment failure may well have occurred in slightly different circumstances.

The person filling in columns 1-6 of the form should be

-the Hirer representative, if it is one of their people injured or a piece of their own or Village Hall equipment that was being used by them

-a member of the Management Committee if it is one of themselves, their employees or someone attending an event organised by them that is injured, or if it is a piece of equipment that was being used by them or by their employees.

1.Date& time

2.What happened

3.Name and contact details of any injured person

4.Name and contact details of a witness

5.Any treatment carried out at the Hall or thought to be necessary elsewhere e.g. at A&E

6.Any suggested remedial action?

7.(Later) Result of investigation by Hall H&S Officer inc. any improvement actions

After reporting the accident/incident to a member of the Management Committee and filling in columns 1-6 please contact the H&S Officer David Hart (tel 01244-381483) and pass it to him after signing your name here:-