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Get Tool 5 : Accident Or Incident Record Form - Hsa

Ale Status (Please tick appropriate box) Pupil Teacher/staff member Visitor Contractor Other (please specify): Date of Accident/Incident: Date Accident/Incident reported to school management: Where appropriate, more then one box in each section may be ticked. TYPE OF ACCIDENT Tick MAIN AGENT WHICH CAUSED ACCIDENT: Injured/damaged by a person Struck by/contact with Caught in/under Slip/trip/fall Sharps Road Traffic Accident/Crash Exposure to substances/environments PART OF BODY.

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