Required field

Please complete this form as soon after the incident as possible. Please complete all fields fully and accurately. Please note, mandatory fields are marked with an asterisk (*) and you will not be able to submit the report if these fields are incomplete.

Initial Incident Information

Type of incident
Others involved in incident ?

Detailed Incident Information & Location information

Full name number category involvement Operations
category
involvement
General location of Incident/Accident
Off campus location or location not listed

Further Information 

First Aider in attendance ?
Emergency services requested ?
UCL Security requested/informed ?
How did you contact UCL security ?

Attachments

By submitting this form, you hereby agree for the Students' Union Health & Safety Team to contact you, and any others who have been involved in an incident.