Personal Accident and Incident Report Drop-Down Crib Sheet

About You:

Your Base / Employment / Length of service / Job Type / Age
BFS
BHX
BOH
BRS
CWL
DSA
DUB
EMA
EXT
GLA
LGW
LTN
MAN
NCL
STN
Wigmore
Overseas (Specify)
Other (Specify) / Employee – Thomson Airway
Contractor
Deliver driver
Visitor
Other (specify) / < 1 month
1 – 6 months
6 – 12 months
> 12 months / Admin
Apprentice
Auditor
Cabin Crew
Captain
CM
Cleaner
Customer Service
Director
Engineer
Flight Ops
Ground Ops
Manager
Pilot
Storeman
Supervisor
Work experience student
Other (specify) / <18
18 – 24
25 – 34
35 – 44
>45

About the Accident: Drop-Down Options

General Location / Location on ground / Location on aircraft / Task being performed / Flight Phase
ABZ
BFS
BHX
BOH
BRS
CVT
CWL
DSA
DUB
EDI
EMA
EXT
GLA
LBA
LGW
LTN
MAN
NCL
STN
Hangar
In Flight
Public road
Training school (EMA)
Training school (LGW)
Training (other venue)
Overseas (Specify)
Other (Specify) / Airbridge
Airport
Cabin trainer
Car park
Classroom
Crew room
Downroute – hotel
Downroute – beach
Down route - restaurant
Downroute – other
Fire trainer
Footpath/walkway
Hotel
Line station
Office
Ramp
Runway
Security
Simulator
Slide trainer
Stand
Stores
Terminal
Vehicle
Workshop
Other (specify) / Aircraft steps
Boarding areas
Cabin
Cargo bay
Door location
Engine
Flight deck
Front galley
Fuel tank
Hold
Jump seat
Nose
Passenger aisle
Passenger seat
Rear galley
Tail
Toilet
Wheel
Wing
Other / Administration
Auditing
Bar service
Checks: Pre-departure/security
Cleaning
Dispatch/ground service
Driving
Duty free service/sales
Eating / drinking
Emergency
Flying
Inspection
Leisure
Maintenance/Repair
Manual handling
Moving around
Opening/closing aircraft door
Passenger in vehicle
Preparing food/drinks
Safety demo
Securing galley/cabin
Serving food/drinks
Sitting down
Training
Walk around
Work at height
Other (specify) / On ramp
Boarding
Pre-departure
Push back
Taxi out
Take off
Climb
Cruise
Descent
Holding
Approach
Landing
Taxi-in
Disembarking
Maintenance
Turnaround
Other (specify)
Not applicable

About the Hazard Event: Drop-Down Options

Hazard Event / Exposure to / Manual Handling / Struck by
Exposure to
Fall from height
Manual handling
Road traffic accident
Slip, trip, fall
Struck against
Struck by
Other (specify) / Hot food/drink/water or steam
Contact with hot surface/fire
Contact with cold
Turbulence
Heavy landing
Hazardous substance (specify)
Fumes/Smoke
Dust
Hydraulic fluid
Asphyxiant
Biological agent
Human waste
Contaminated food/drink
Machinery
Radiation / Aircraft doors
Aircraft seats
Aircraft equipment
Aircraft panels
Aircraft spares
Bags – own
Bags – passenger
Batteries
Brakes
Carts
Catering boxes
Catering pack
Emergency slide
Equipment (specify)
Gas cylinders / Aircraft doors
Aircraft door handle
Assault – colleague
Assault – other
Assault – passenger
Cart
Colleague
Cupboard door
Doors
Equipment (specify)
Falling object (specify)
Flight deck panel
Flying object (specify)
Galley cupboards/doors
Machinery (specify)
Exposure to continued / Manual Handling continued / Struck by continued
UV
Bright/intense light
Electricity
Static discharge
Noise
Vibration
Asbestos
Sharp object
Needle stick
Insect bites
Animal
Other / Mobile steps
Person
Poly bags
Sharp object
Slide
Tools
Torqueing nuts
Trolley
Waste / rubbish
Wheels
Other (specify) / Moving object (specify)
Moving vehicle Passenger
Other person
Other (specify)
Striking against / Slip, trip, fall / Falls from height / Road traffic accident / Other
Aircraft fuselage
Aircraft equipment
Bulkhead
Carts
Equipment (specify)
Fixed object (specify)
Flight deck panel
Galley cupboards/doors
Galley work surface
Machinery (specify)
Seat
Video monitor
Other (specify) / Caught footing
Contaminated surface
Debris
De-icing fluid
Footwear
Icy surfaces
Lost footing
Obstructions
Potholes
Rushing
Slippery surface
Turbulence
Uneven surface
Unexpected movement
Wet surface
Other (specify) / Aircraft doors
Aircraft docking
Aircraft exterior
Aircraft seat
Ladder/steps
Lost footing
Platform
Waste chute
Other (specify) / Collision
Shunt
Other (specify) / Body movement
Trapped
Unsafe practice
Other (specify)

About the Injury:Drop-Down Options

Injury Type / Part of body / Treatment received / Side of body / Did you…
None
Amputation
Asphyxiated
Bite / Sting
Bruise
Burn – chemical
Burn – heat
Crush
Cut
Diarrhoea
Diarrhoea & vomiting
Dislocation
Foreign body
Fracture
Generalised pain
Headache
Hernia
Hypothermia
Inflammation/swelling
Internal
Irritation
Laceration
Light headed/dizzy/faint
Loss of sight
Nausea
Penetration/puncture
Scald (Hot water/steam)
Scratch/abrasion
Shock
Sprain/strain
Unconscious
Vomiting
Other (specify) / Head
Face
Eye(s)
Nose
Mouth
Ear(s)
Neck
Shoulder
Arm
Elbow
Wrist
Hand
Finger(s)
Thumb
Back
Chest
Stomach
Side
Buttocks
Hip
Groin
Leg
Knee
Ankle
Foot
Toe
Whole body / None
First aid (self administered)
First aid (administered)
Doctor - GP
Doctor - company
Doctor - hotel
Doctor – other (specify)
Hospital
Paramedics
First aid & Doctor
First aid & hospital
Doctor & Hospital
Paramedics & Hospital
First aid, paramedics & hospital
First aid, Doctor & Hospital
Other (specify) / Left
Right
Middle
Various / Become unconscious
Need resuscitation
Hospital stay > 24 hours
None of the above
All of the above
Document / Personal Accident and Incident Report Drop Down Crib Sheet / Issue / 3
Department / Risk Safety and Quality / Page / 1 of 2
Authority / Occupational Risk Manager / Date / December 2010