Data incident
Note: Always report acute situations via 22222 or 020 - 59 82222
Category
Subcategory
Date/time
Location/building
Additional information location/building
Faculty/department
When describing the event, consider "possible causes", "conditions and location", "fire alarm", "type of work", "personal protection", "safety features".
Description of the event
A serious accident is an accident with injury with hospitalization, permanent (psychological or physical) injury or a fatal accident.
Was it a severe incident?
Report this accident directly to the SZW Inspectorate via 0800 - 5151 (free) or online.
Notifiable an accident at work if the victim:
• dies from the consequences
• permanent injury occurs
• whether to be hospitalized
• or in the event of an accident that (possibly) led to the release of biological agents of category 3 and 4 and that may cause contamination of employees by these agents.
Was hospitalization necessary?
Which hospital and adres
Has the person been injured or become ill as a result of the incident or through contact with or exposure to hazardous materials?
Nature of injury (multiple options possible)
In case of 'other', always give an explanation.
Additional information possible injury
Can absenteeism be expected as a result of the injury/infection?
Which measures have been taken immediately following the incident or accident to limit the consequences? (multiple options possible)
In case of other, always give an explanation.
Any further information regarding the measures taken
What are the chances that this will happen again?
Details reporter
Would you like to share your personal details?
Firstname
Insertion
Lastname
Incident reported by
Faculty/department
Telephone number
Would you like to receive further notifications about this report?
E-mail
How were you involved in the incident (multiple options possible)
In case of other, always give an explanation.
Additional remarks and/or explanatory notes regarding your involvement or report:
Details victim
Enter the data of the victim here.
Details on victim
Are you also the victim?
Firstname
Insertion
Lastname
Faculty/department
The victim is a
Private address
Zipcode and town/city
Telephone number
E-mail
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