Home

Online forms: Public Liability Claim Form (Overseer/engineer/supervisor)

Details

Please ensure photos of accident scene are taken prior to repairs/modification work being carried out.

Name Required

Title Required

Email address Required

Describe action taken when you first became aware of the incident Required

Was this action of a temporary nature? Required Yes No

When was this incident first brought to your attention? Required

When will permanent work be carried out?

If no action was taken, give reasons why

Had you received any prior complaints/reports/notifications regarding this 'hazard'? Required Yes No

Were you aware of any 'hazard' in the area, prior to the incident? Required Yes No

Please state the hazard

What in your opinion was the cause of the accident? Required

Further comments you may have in relation to the incident