Equity Minor Incident Report Form

Equity Minor Incident Report Form

INCIDENT CLASSIFICATION GUIDE

Category 1:

A MAJOR / CRISIS INCIDENT (e.g. death has occurred or is likely, a substantial hotel fire, an avalanche in resort with associated missing persons, a substantial coach / train / ferry crash, a substantial negative affect (actual or potential) on normal business operations).

Category 2:

LIFE THREATENING SERIOUS INJURY,( e.g. significant head/ internal/ spinal injury, multiple broken bones or group multiple injuries, mass illness, or a situation where there is an evident need to protect children from harm or an inability to deliver a substantial part of an individual / low number of trip(s).)

Category 3:

GENERAL INJURY / ILLNESS (e.g. a fractured bone, a ligament / muscle tear, a cut requiring stitches, substantial sickness, minor concussion or a significant theft

Category 4:

NOTEWORTHY, BUT OF NO SIGNIFICANT DETRIMENT (e.g. a twisted ankle, a strained muscle, a cut / bruise / graze, a sore throat, minor sickness, minor theft / loss of belongings, or a coach ‘bump’. or a near miss event (where no actual significant harm occurred, but could have occurred)


Minor Incident Report

Details of the incident

Please indicate which category you believe the incident falls under.(*)
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PLEASE CONTACT YOUR LINE MANAGER IMMEDIATELY -
DUTY OFFICE TELEPHONE: 07895 395 281

You do not need to fill out this form for Category 1 or Category 2 incidents

Incident Type:(*)
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Name of Individual:(*)
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Adult/ Child(*)
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Name of Group:(*)
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Booking Reference:(*)
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Tour type(*)
Please choose a tour type

Name of Group Leader:(*)
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Date and Time of Incident:(*)

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Destination / Resort:
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Hotel Name:
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Location of incident:
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Fully describe the incident / accident and who was involved:
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Please include : -Medical Status -Current location -If there were any contributory factors?

Did any of the group receive medical treatment?
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Please provide full details of any medical treatment received:
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Please state name and address of doctor or clinic attended:
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Name of witness:
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Address of Witness:
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Telephone no of Witness:
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Could this incident have been avoided or prevented in any way?
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Who was the incident reported to:
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Please tick as applicable

Please give details:
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Details of Reporter

Full Name:(*)
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Position Held:(*)
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e.g. Rep, Party Leader

Contact Tel / Mob : (*)
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Email address:
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