Health and Safety
Health and Safety at Work etc Act 1974
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
Report of a dangerous occurrence
This form is for duty-holders only to report defined Dangerous Occurrences under RIDDOR. It is not for
making a complaint about or reporting a workplace issue. Advice on this is available on the HSE website.
About you and your organisation
*Your Phone No
Address Line 1
(eg building name)
Address Line 2
Address Line 3
*Did the incident happen at the above address?
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About where the dangerous occurrence happened
*Where did the incident happen?
Elsewhere in your organisation
At someone else's premises
In a public place
Details of where the incident happened (if the address is not known)
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About the dangerous occurrence
(24 hr clock)
In which local authority did the incident occur?
Please refer to the help for guidance on the local authority
In which department or where on the premises/site, did the incident happen?
What type of work was being carried out (generally the main business activity of the site)?
*Type of dangerous occurrence
Type of dangerous occurrence
Dangerous occurrence type specific to mines (if applicable)
Dangerous occurrence type specific to quarries (if applicable)
*Describe what happened
Please check your email address below. Ensure that you change if incorrect as this is the email address that
your acknowledgement and a copy of the form will be sent to.
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