ONR Incident Notification Form
This is a preliminary report of an incident affecting an activity or site regulated by ONR and is without prejudice to the results of further investigations, it is provided for Information ONLY at this stage. Note: Do not use the information provided without reference to ONR.
Indicate Protective Marking: / OFFICIALOFFICIAL SENSITIVENOT PROTECTIVELY MARKEDPROTECT - COMMERCIALPROTECT - REGULATORYRESTRICTED (not to be emailed outside of GSI)UK RESTRICTED (not to be emailed outside of GSI)CONFIDENTIAL (not to be emailed outside of GSIX) /Note - for information on how to use fields (bracketed areas), select a field and press the F1 key.
Part A – Completed by reporting site unless an alternative is agreed / Site’s reference no.:1 / Report source
Select site and operator name from list below or specify other: / Give details of person to be contacted for further information:
Operator – Site: / Incident Date/Time:
Operator other: / Site other: / Report Date/Time:
Details from: / Mobile:
Office telephone: / Email:
2 / Nature and consequences of incident / Incident description: include affected plant, current plant status, outline actual or potential consequences, any mitigating action; complete sections below.
Plant or area affected:
Description:
Initial action taken by licensee/operator:
Initial estimate of significance: ------Major Moderate Minor None
Radioactivity released: / No Yes / If yes, provide details:
Workers affected: / No Yes / If yes, provide details:
Public affected: / No Yes / If yes, provide details:
External services involved: / Fire: Police: Ambulance: Other (Specify)
Provisional INES Rating: / ------Not applicable Not known 0 No safety significance 1 Anomaly 2 Incident 3 Serious incident / Licensee categories:
3 / ONR category / Give only one best fit category from ONR lists in tables provided in ‘Guidance for notifying and reporting incidents and events to ONR’
Table: / Nuclear
NS---- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 / Radiological
RS---- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 / Security
SC---- 10a 10b 10c 10d 10e 10f 10g 10h 10i 10j 18 22a 22b 22c / Safeguards
SG----010203040506070809 / Transport
TS----01020304a04b0506070809 / Other
AN01
Category:
4 / Other reports / Confirm which other notifications have been or will be made.
Report to other organisations: / EA/SEPA Media DECC/MOD for Minister Devolved Gov’t Euratom SI
5 / Any other comments / Use this section for further explanation to aid understanding of the circumstances of the incident. Include any investigations begun or planned or any wider implications for other facilities.
6 / ONR contact details for this form / For notifications outside office hours, (0830 – 1700 hrs Mon – Fri) telephone ONR Emergency Contact (Tel: 0151 922 9235) or for security incidents CNS Duty Officer (Tel. 01235 466466).
ONR e-mail address / Telephone / Fax
Security incidents under NISR 2003 / Telephone Nominated ONR (CNS) Site Inspector or Duty Officer 01235 466466
Transport Incidents / / 0207 556 3475 / 0207 556 3480
All other incidents / / 0151 9514081 / 0151 9513942
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