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waste cardboard packing machine - The W1nners' Club

1.    About the person who had the accident:

Name: Andrew Davies
Address: 24 Smith Street, Bolton, Lancashire
Postcode: BL4 3BD
Occupation:  Warehouse Manager

2.    About you the person filling in this record:

Complete if you did not have the accident:
Name: Paul Sykes
Address: 83 Caledon Road, Bolton, Lancashire
Postcode: BL2 4DY
Occupation: Warehouse Operative

3.    About the accident:

Say when it happened:
Date: 28/07/2017 Time: 5:30PM
Say where it happened (which room or place):
Waste Cardboard Packing Machine
Say how it happened (include the cause if you can):
The waste cardboard packing machine got jammed and Andrew told me to climb inside to try and fix it. I told him that in my induction training we were strictly told not to climb in the machine under any circumstances. Andrew said that this was ‘a load of bollocks’ and that the health and safety training is only given to ensure the company remains compliant with the law. Upon climbing inside, the machine unjammed itself and ended up packing Andrew along with 30 other cardboard boxes.
Say if the person who had the accident suffered any injury:
Well – he certainly won’t be able to do any boxing any time soon (pun fully intended).
Please sign and date:
Sign: signature 2 - The W1nners' Club Date: 28/07/2017

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: Date: 28/07/2017

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? Paul Sykes made us aware of what had happened when he asked if someone could call an ambulance for Andrew Davies who was unfortunately tightly bound up in a pile of flattened cardboard boxes. We weren’t able to see him but could hear his muffled wailing from somewhere deep inside the pile.
Sign: signature 1 - The W1nners' Club Date: 28/07/2017


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