Millars Storage

Accident & Injury Report

Use this form to report an accident or injury at the site. Submissions are emailed straight to Millars Storage.

In an emergency call 999 first.

Only fill in this form once anyone needing urgent help has been looked after. For non-emergencies you can also call Tara Coles on 07734 888326.

Site: The Studio, Station Road, Cliddesden, Basingstoke RG25 2NL

Contact: Tara Coles, Millars Storage · 07734 888326

Required

1. When did it happen?

Date of incident

Time of incident

2. Injured person

Full name

Phone

They are a

Customer Visitor Contractor

3. Where on site?

Location

Unit or container number (if known)

4. What happened?

Describe what happened

Injury description

5. First aid & emergency care

Was first aid given?

Yes No

First aid details (if given)

Went to hospital or 999 called?

6. Witnesses

Witness names and contacts (optional)

7. Reporter (if different from the injured person)

Reporter's name

Reporter's phone or email

8. Privacy I understand these details are used only to record and follow up this incident, and will be kept for at least 3 years as required for accident records.

This form emails Millars Storage. In an emergency call 999 first. For urgent non-emergency help call 07734 888326.

Accident & Injury Report

Report received – thank you