ࡱ> 3 0Cbjbjzz nhhn n 8LDH7vL6666666$9t<6A"AA67111AF61A61181W3ЃqPd^2670H72==433=31 X66vH7AAAA=n X : HEALTH AND SAFETY SERVICES  INCIDENT INVESTIGATION REPORT Health and Safety Services Incident Number:RIDDOR Reference (if applicable):Date of Incident:School/Function:Department/Area:Name of Injured Person (if applicable):Injured Person contact details (if not already provided on Incident Report Form) :Date(s) of investigation:Investigated by:Persons contributing to the investigation: 1. INCIDENT DETAILS - gather the facts Circumstances & sequence of events Injury / ill health / damage sustained & treatment given: Date first day away from work (if applicable): Date first day return to work (if applicable):1.4 Details of plant / equipment / substances / location (include photographs and sketches) 1.5 Witnesses (attach statements) 1.6 Management / emergency response to the incident  2. INVESTIGATION FINDINGS2.1 Immediate cause(s) 2.2 Underlying and contributory factors 2.3 Conclusions and comments 3. Improvement recommendationsAction requiredBy whomBy when Name of Report Author: Date of Report: Please return the completed form to your H&S Services Liaison Adviser and also via the H&S Service inquiry email address, safety@reading.ac.uk. Thank you, the H&S Service team. The information contained with this report must be treated in confidence, stored and shared securely. This information is only to be shared with those involved in the management of health and safety accident and incident response and on a strictly need to know basis. 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