TIN CHAPEL FORM TC-F-006
ACCIDENTS AND NEAR-MISSES

Name of person reporting:

Date of accident or near-miss:

Time:

Location:

Was this an accident or a near-miss?

Person or persons involved:

Description of what happened:




Was anyone injured? Yes / No

If yes, describe the injury:

Was first aid given? Yes / No

Was the Caretaker informed at the time? Yes / No

If no, explain why this is now being brought up:


Immediate action taken:

Further action requested:

Declaration:
I confirm that the information above is accurate to the best of my knowledge
and has not been improved for dramatic effect.

Signature:

Date:

SENDING INSTRUCTIONS
Please submit completed forms using the Contact page on the Tin Chapel website.
In the message field, write "sending form".

When the message opens in your normal email application, remember to attach the
completed form before sending. The website cannot attach it for you, whatever
may seem reasonable at the time.

Alternatively, just copy/paste the form into the message body. 
Do not change the format.