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Health and Safety

Executive

The Electricity Safety, Quality & Continuity Regulations 2002

Report of an ESQCR incident

*What type of incident are you reporting?

About you and your organisation

(eg building name)

(eg street)

(eg district)

Page 1 of 7


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Health and Safety

Executive

Report of an ESQCR incident

About where the incident happened

*Where did the incident happen?

(eg building name)

(eg street)

(eg district)

Page 2 of 7


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Health and Safety

Executive

Report of an ESQCR incident

About the incident

Is the incident a reportable dangerous occurrence under RIDDOR?

 

(24 hr clock)

Note: Incident date & time not required for supply interruptions

(in metres)

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Health and Safety

Executive

Report of an ESQCR incident

Incident details - supply interruptions only

(24 hr clock)

(24 hr clock)

MW (megawatts)

Page 4 of 7


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Health and Safety

Executive

Report of an ESQCR incident

About the incident - domestic fatalities only

(in volts)

Earthing arrangements

*Was the earthing connection loose?

 

*Was the earthing connection disconnected?

 

*Was the earthing connection in contact

with a phase conductor?

 

*Was earth loop impedance measured?

 

(in ohms)

Circuit protection details

Equipment involved details

*Was the equipment faulty?

 

*Was there evidence of amateur

work?

 

Inquest findings

Page 5 of 7


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Health and Safety

Executive

Report of an ESQCR incident

About the people involved and their injuries

Person details

*For each person who died or was injured, please enter the details and select Add. Repeat for each person involved.

Is the injury reportable under RIDDOR?

 

*What was the severity of the injury?

Name of the injured/deceased person

*Gender

*At the time of the incident, was the deceased/injured person:

Page 6 of 7


HSE Logo

Health and Safety

Executive

Report of an ESQCR incident

Submit your notification

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.

To ensure that your notification is sent to the appropriate office, please confirm the local authority area nearest to the

location where the event occurred.

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