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Report an incident

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About the affected person
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Home address details




Student details

Department details


About the person filling in this form
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Home or company address details



Location of incident





Responsible person for where the incident occured






Details about the incident



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Injury details









Accompanied person details






By submitting this form you confirm that the information you have provided is accurate to the best of your knowledge. I also give my consent to Leeds Arts University to disclose my personal information and details of the incident which appear on this form to safety representatives and representative of employee safety for them to carry out the Health and Safety functions given to them.