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Health and Safety

Executive

Health and Safety at Work etc Act 1974

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013

Report of a gas-related injury

A report of a flammable gas incident will ask for the number of injured persons and their names.

You will need this information to complete and submit the form.

About you and your organisation

(eg building name)

(eg street)

(eg district)

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Health and Safety

Executive

Report of a gas-related injury

About the gas incident

*What was the main cause of the incident?

*Where did the incident happen?

(eg building name)

(eg street)

(eg district)

*In which local authority did the incident happen?

Please refer to the help for guidance on the local authority

*Was it in a building?

*Were the premises rented?

What is the name of the person living in the premises?

*Is the resident contactable?

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Health and Safety

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Report of a gas-related injury

Details of the landlord or their managing agent

(eg building name)

(eg street)

(eg district)

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Health and Safety

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Report of a gas-related injury

Contact details of someone other than the resident

(eg building name)

(eg street)

(eg district)

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Health and Safety

Executive

Report of a gas-related injury

About those injured as a result of the incident

People injured as a result of the incident

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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