Have you been to GP
GP details
Have you been to Hospital
Hospital Details
Other Party details/Person to blame
If RTA other vehicle details & Drivers information
If Slips and TRIPs
Full details of the premises & Location
If Work accident:
Company Name & Address
Has this been reported to Manager
Has this Incident been reported in Accident book
Has Ambulance attended
Any First Aid given
If Medical Negligence or Hearing Loss:
GP/Hospital details and address
Treatment details
Appointment/visit dates
Person in Charge for the treatment
Once you have completed the form, click on send
