TEST MODE ACTIVE
Sending to:
Safety
Report
Depot
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Driver Name
Phone
Date
Time
Select Report Type:
Near Miss / Hazard
Incident
Location
Customer Site Name
Site Address
GPS
What3Words (Optional)
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Find
Area on Site
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Delivery Point
Loading Bay
Weighbridge
Silo
Tanker Bay
Parking Area
Public Road
Site Access/Egress
Other
Was this planned location?
Yes
No
Category
Classification
Near Miss
Hazard Observed
Unsafe Condition
Unsafe Act
Environmental Hazard
Behavioural Concern
Description
What happened / could have happened?
What caused the risk?
Who/What was affected?
Driver
Third Party
Pedestrian
Plant/Vehicle
Environment
Risk Factors
Visibility
Daylight
Dark
Dusk/Dawn
Weather
Clear
Rain
Ice/Snow
Fog
Contributing Factors
Not Enough Space
Procedure Not Followed
Personnel (Rude/Abusive)
Site Access/Egress
Slip/Trip/Fall Hazard
General Housekeeping
Split Delivery
Poor Layout (General)
Poor Lighting
Pedestrians
Wrong Equipment
Incorrect PPE
Rushed/Pressured
Obstruction
Uneven Ground
Spillage
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Actions & Severity
Stopped?
Yes
No
Reported?
No
Yes
Called?
No
Yes
Who was it reported to?
Who was called?
Action Taken
Severity
Low
Medium
High
Could have caused serious injury
Witnesses
Important Guidance
Remain calm, professional, and ensure your own safety first.
Do not admit liability or make statements that could be interpreted as accepting blame.
Gather essential details only and be courteous at all times.
Where safe to do so, take clear photographs of the scene, vehicles, road conditions, and any relevant signage or damage.
Record all information accurately on this form and notify the company as soon as possible.
INCIDENT REPORTING MODE
Incident Type
What type of incident?
RTC
Spill
Damage
Other
Describe the incident type
Location
On Road or On Site?
On Road (Public Highway)
On Site (Customer/Depot)
Location / Address
GPS
What3Words
///
Find
Site Name (if on site)
Conditions
Visibility
Daylight
Dark
Dusk/Dawn
Weather
Clear
Rain
Ice/Snow
Fog
High Wind
Road/Ground Conditions
Dry
Wet
Icy
Flooded
Muddy
Loose Surface
Contributing Factors
Not Enough Space
Poor Visibility
Third Party Error
Road Layout
Site Access/Egress
Parked Vehicles
Pedestrians
Speed
Distraction
Obstruction
Equipment Failure
Rushed/Pressured
Hold Ctrl to select multiple
What Happened?
Describe the incident
Fault Assessment
Unknown / To Be Determined
Our Driver
Third Party
50/50 (Shared)
No Fault (Weather/Road etc)
Accident Sketch
Draw a simple sketch
showing how the accident happened. Include vehicle positions, direction of travel, and any relevant road features.
Pen Size:
3
Undo
Clear
Use your finger to draw. This sketch will be attached to the report.
Our Vehicle
Registration
Trailer Number
Damage to Our Vehicle
Injuries
Was anyone injured?
No
Yes
Unknown
Injury Details
Third Party Details
How many Third Parties involved?
0 - No third party
1
2
3
4
Police Involvement
Did Police attend?
No
Yes
Called but did not attend
Officer Name / PC Number
Police Reference Number
Police Station / Force
Other Emergency Services
Other services called/attended?
Ambulance
Fire Service
Highways Agency
Recovery Service
Witnesses
Any witnesses? (Not including Police)
Evidence (Max 5 Photos)
Add Photos
Photos help with insurance claims and investigations. Capture: scene overview, damage, road conditions, signage.
SUBMIT REPORT
Report Sent Successfully!
