Incident and Hazard Report Form
v3.1
Purpose. Workers complete this form to report any injury, near miss, gas escape event, third party damage, environmental incident or hazard so that it can be recorded, investigated and reported to the regulator where required.
1.When to use this form
Complete this form on the day of any injury, near miss, uncontrolled gas release, third party damage to the network, environmental incident or hazard you cannot fix yourself. Your supervisor will enter the report into the HSE Incident and Hazard Register and HSE will decide whether the event must be notified to the regulator.
2.Immediate actions
Make the area safe before you complete the form. Where someone is injured, give first aid and call emergency services if required. Preserve the scene where practicable so that the investigation can establish the facts.
3.Describing the event
Describe what happened in the order it happened, using plain language and measurements where you have them, for example detector readings and pipe sizes. Record who was present and what equipment was in use. Do not speculate on blame.
4.Classification
Choose the classification that best fits. Gas escape events are classified by whether gas entered a building, whether there was ignition and whether supply was lost. Third party damage must record the excavator's name and whether a locate had been requested.
5.After submission
The supervisor must review the form within one shift and HSE must assign an investigation level within two working days. Notifiable incidents must be reported to the regulator within the time the law sets, so submit the form promptly.