Accident Report Form (ARF-01)

Please complete & submit this form and bring to the attention of your Area Manager of any accident/incident. Please also email any additional information or pictures to your Manager or Hanley Safety Officer. Please note that all accidents, incidents & near misses at work must be reported. Hanley will inform the HSA if an employee is unable to carry out their normal work duties for more than three (3) consecutive days, excluding the day of the accident. We are obliged to report all non-fatal accidents or dangerous occurrences to HSA within ten (10) working days of the event.
Name of Person Making Report
Name of Injured Party
Time of Accident/Incident
:
DD dash MM dash YYYY
Please include as much information as you feel is relevant to give an accurate account of the accident.