Health and Safety
The Electricity Safety, Quality & Continuity Regulations 2002
Report of an ESQCR incident
*What type of incident are you reporting?
About you and your organisation
*Your Phone No
Address Line 1
(eg building name)
Address Line 2
Address Line 3
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About where the incident happened
*Where did the incident happen?
Details of where the incident happened (if the address is not known) / name of substation / offshore windfarm
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About the incident
Is the incident a reportable dangerous occurrence under RIDDOR?
(24 hr clock)
Note: Incident date & time not required for
*Locale of incident
If overhead conductor, height of conductor
*Desciption of the incident
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Incident details - supply interruptions only
*Details of the geographical area that has been affected by the interruption
*Interruption start date
*Interruption end date
*Load affected by the supply interruption
*No of consumers affected
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About the incident - domestic fatalities only
*Was the earthing connection loose?
Type of earthing connection
*Was the earthing connection disconnected?
*Was the earthing connection in contact
with a phase conductor?
*Was earth loop impedance measured?
Circuit protection details
*Details of the circuit protection applying
*Details of the extent of the operation protection
Equipment involved details
*Type and make of the equipment involved
*Was the equipment faulty?
Faulty equipment type involved
*Was there evidence of amateur
Details of the findings from the inquest held on the incident if known
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About the people involved and their injuries
No of people who died
No of people injured
*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
*Deceased / Injured person's injuries
(provides help on the injuries selected)
*Part of the body affected
*At the time of the incident, was the deceased/injured person:
Not at work
List of fatalities and injuries
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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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