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Arborist - The W1nners' Club


1.    About the person who had the accident:

Name: James Green
Address: 65 Appleby Grove, Smithfield, Derby
Postcode: DE41 7AG
Occupation: Head Arborist

2.    About you the person filling in this record:

Complete if you did not have the accident:
Name: Simon Green
Address: 65 Appleby Grove, Smithfield, Derby
Postcode: DE41 7AG
Occupation: Assistant Arborist

3.    About the accident:

Say when it happened:
Date:07/03/2017 Time: 16:00PM
Say where it happened (which room or place):
Smithfield Park, Derby
Say how it happened (include the cause if you can):
My older brother James is a senior partner in our father’s Arborist firm. Every Friday if we are not too busy, it is customary for us to finish up early and go down to the pub to celebrate the end of the working week. I have only just started my apprenticeship with the firm and my older brother was trying show me how I spend too much time preparing the felled branches for grinding in the wood grinding machine. He said that because of time constraints, I should forget what I was told in training and put a larger number of branches into the grinder so that we could finish the job and get down to the pub as soon as possible. Unfortunately, my brother happened to be wearing trousers that were slightly flared at the bottom and they unfortunately got caught up in the grinder’s teeth as he attempted to stamp the largest branch from a Silver Birch tree into the machinery (see picture attached). Despite my repeated calls for him to, “Pull your f*cking leg out!” my brother unfortunately was unable to heed my advice and disappeared into the grinder along with the branch. Needless to say I was forced to go down to the pub on my own.
Say if the person who had the accident suffered any injury:
It’s hard to say as there wasn’t much left of him when we finally managed to remove his belt from the machine jaws which had been unfortunately jammed by the buckle.
Please sign and date:
Sign: Signature - The W1nners' Club Date: 07/03/2017

4.    For the employee only:

By ticking this box, I give my consent to my employer to disclose my personal information and details of the accident, which appear on this form to safety representatives to carry out the health and safety functions given to them by law.


Sign:Signature - The W1nners' Club Date: 07/03/2017

5.    For the employer:

Complete this box, if the accident is reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).
How was it reported?

We received a phone call from the pub late on Friday evening to say that James has had an accident and won’t be coming in to work on Monday. His brother Simon asked if he could have James’s locker at the depot as he didn’t think James will be requiring it anymore.

Sign: signature 2 - The W1nners' Club Date: 07/03/2017



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