aaa Test Incident Page Dyson Farming Occurrence Report Form - WORKFLOW TEST Name First Last Please leave blank if you wish to report an occurrence anonymously Date of incident* MM slash DD slash YYYY Time of incident* Hours : Minutes Department incident occurred within*Carrington ADNocton ADNocton FarmCarringon FarmGlasshouseNocton Estate OfficeLocation of IncidentPlease provide detailed location eg What3Words, field number, etcIncident Type* Hazard Near Miss Accident resulting in damage Accident resulting in damage and/or injury HazardHazard details*Has hazard been removed?* Yes No If hazard has not been removed please remove or report to area manager. Near MissWhat happened?*Who was involved?*Which category does this fall under: Slips, trips & falls DSE Machinery Electrical Workplace driving Movement of vehicles and pedestrians COSHH Noise Fire Manual Handling Did this nearly result in damage and/or injury? Damage Injury None What prevented this from being an accident?Did the near miss involve any of the following The failure of a pressurised system The collapse, overturning or failure of lifting equipment Contact with overhead powerlines Fire or explosion Explosives Release of biological agent The malfunction of breathing apparatus The malfunction of radiation equipment Diving operations Collapse of scaffolding Injury InformationWho was injured?*Is the injured person an employee?* Yes No Was the accident work related?* Yes No Was the injured person taken from where the accident happened, to a hospital for treatment?* Yes No Accident InformationWhat was happening before the incident?*Background of what was happening before the incident occurred How did the accident happen?*What were the conditions at the time of the accident? Dry ground Wet ground Cloudy Icy/Snow on groung Low sun Raining/hailing/snowing Foggy Dark Normal daylight Which category does this fall under: Slips, trips & falls DSE Machinery Electrical Workplace driving Movement of vehicles and pedestrians COSHH Noise Fire Manual Handling Damage InformationWhat was damaged?* DFL Vehicle DFL Property DFL Staff Vehicle DFL Staff Property Third Party Vehicle Third Party Property Reg of damaged vehicle(s)*What damage occured?*Incident may be RIDDOR reportableSubmitIf you have any photos upload them here: Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 10.
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