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University of Northampton
Accident / Incident Report Form.
This form has implemented reCAPTCHA v2 this is the used to fight spam and abuse on this form.
Please tick the "I'm not a robot" box and follow any instructions.
When the green tick shows click on 'Next' to continue.
This section MUST be completed. Where there is more than one injury place a number on the part of the body affected and put the same number in the type of injury.
This form will be held by the university for the period detailed in our Record Retention Schedule. The information within it may be used during accident/incident investigation or to prevent reoccurrence. It may also be disclosed to legal or other third party professionals should the need arise.
I confirm that the above information is correct to the best of my knowledge and consent to the release of this information for the purposes mentioned above.