Accident & Near Miss Report – Titan Drylining Forms Portal

Please ensure you have followed Titan’s Accident Procedure!

Complete this form to report an incident or unsafe situation on site, for prevention of future incidents.

If you require any assistance, do not hesitate to contact Titan’s Health & Safety Advisers: HCS Safety Ltd – 02380 894 695
Incident:*
Date of Incident:*
DD slash MM slash YYYY
Time of Incident:

: Hours

Minutes

AM/PM
Site's Principle Contractor:*
Site Address:*
Full Name of Injured Person:*
Injured persons contact number and addess:
Descrition of injuries sustained:
General Description of Incident:*
Particular safety downfalls that may have led to the incident:
Action taken at time of incident to prevent further risk:
Further preventative action needed to remove foreseeable risks:
Upload Photo
Max. file size: 2 MB.
Accident/Near Miss Form Completed by:*
Date*
DD slash MM slash YYYY
Signature
Any Other Comments: