Reporting System

The simple system below demonstrates the ease at which a system can be developed using close calls or suggestions as an example.

I am currently working on developing dynamic functionality enabling the system to generate a document (pdf, docx) detailing the content of the submission and providing an electronic copy to the reporting individual.

More recently I have been developing with colleagues’ systems using Power Automate etc.

All mandatory fields are indicated with a star *

Reporting System

Reporting System

Accident/Incident, Near Miss/Close Call, Suggestion or report of verbal physical aggression

About you

I am a * Please selectColleagueContractorA N Other Person

I work in… * Please selectWhoeverWhereverHowever

My job title is

Accident/Incident, Near Miss (Close Call) an Incident of Violence Aggression or Suggestion

I am submitting a: *

Accident or Incident Report

Near Miss (Close call)

Incident of Violence or aggression

Suggestion

Suggestion Details

Please enter details of your suggestion. *

Photos

Do you have photos? *

No

Yes

File Upload *

Drop a file here or click to upload Choose File

Maximum file size: 40MB

Learning from Near. Miss/Close Call

Could this have been avoided?

Yes

No

Why could it not have been avoided? *

How could it have been avoided? *

Report of verbal abuse, violence or aggression

Date / Time of Close Call *

Date

Time

121234567891011 : 0030 AMPM

Time

Location where this occurred *

Please describe the event in detail. *

Did you advise your line manager? *

Yes

No

Have the relevant entries been made on appropriate systems? *

Yes

No

If yes please identify which systems? *

If No please explain why? *

Details of the Near Miss/Close Call

Date / Time of Close Call *

Date

Time

121234567891011 : 0030 AMPM

Time

Location where Close Call occurred *

Please describe the event in detail. *

Was any damage done? *

Yes

No

Please enter details of the damage *

Are you reporting on behalf of another person?

Yes

No

Name of person of whom report is being made *

Name of person of whom report is being made

First

First

Last

Last

Accident details

Area of body injured

Hands

Head

Injury as a resuit of….. Manual handlingWork at Height

Was there a witness?

Yes

No

Name of witness address

Name of witness address

First

First

Last

Last

Address of witness

Address of witness

Address of witness

Address of witness

City

City

County

County

Zip/Postal

Zip/Postal

If you are human, leave this field blank.

Submit