Health and Safety Report Name of person filling out report * First Name Last Name Organisation Contact number Email Date MM DD YYYY Name of person in report (person injured, hurt, or that the report concerns) First Name Last Name Phone number for person (###) ### #### Type of report Accident Incident Near miss Violence Ill health Safety Concern What happened? what happened, when, and who was involved? Were there any injuries? Or anybody hurt? Why did it happen? Were the emergency services called? Were there any witnesses? I confirm that the information above is a truthful account of what happened to the best of my recollection. * Yes No Thank you!This email is sent to the foundry manigment team and we will be in contact shortly to address the issue.
