Date of Incident

What date did this incident occur?
Which country did this incident occur?
Company Responsible for Work Task
Which company was responsible for the work task?
Incident Outcome
What was the main outcome?
Injuries that prevent the a person working for more than seven days.
Injuries that prevent the person working from one to seven days.
A person suffered an injury but was able to continue work that same day. This may involve medical care, assessment or a visit to a hospital.
No injury or damage occurred, however there was significant risk.
People Involved
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What is the machine brand?
What is the machine model?
Machine Category
What category is the machine? If you are unsure, please visit www.ipaf.org/categories
Static vertical
Push around verticals
Static Boom: trailers/push-arounds
Static boom: self-propelled tracked (outriggers)
Static boom: vehicle-mounted
Mobile vertical
Mobile boom: self-propelled
Mobile boom: self-propelled tracked
Goods Hoist
Transport Platform
Personnel Hoist
Machine Activity
How was the machine positioned when the incident occurred?
Industry Sector
What is the type of industry?
What is the type of industry?
Where did the incident happen?
Commercial premises including warehouses and factories
Shopping centres and other pedestrianised areas where there is no vehicular traffic
Working on or alongside roads and highways where there is vehicular traffic
Powered access training centre
Rental company or manufacturers workshop
Rental company yard
Ground Conditions
What were the ground conditions when the incident occurred?
Time and Light Levels
When in the day and what were the light levels when the incident occurred?
Weather Conditions
What were the weather conditions when the incident occurred?
Wind Strength
What were the wind conditions when the incident occurred?
Incident Classification
What type of incident occurred?
Person(s) have fallen from the work platform. They may have been ejected from the work platform as a result of the MEWP movement.
Person(s) have fallen from another structure (roof, tree).
Slipped, tripped, fell from same level
Fingers, hand, body crushed or pinched in machine or components, for example between the wheel and extending structure, between the scissor arms, between the folding guardrails.
Person’s upper body/head trapped or crushed between the work platform and an external structure, following movement of the MEWP (travel or elevation).
The MEWP has been struck by an external object for example a tree branch, sign or a part of the building under construction/destruction.
The MEWP has been struck by another moving machine, for example a truck, car, train, gantry crane or forklift.
Road Traffic Accident (RTA)
Electrocuted following contact with electrical current resulting in fatality.
The MEWP or MCWP catches fire or materials or structures adjacent to the platform catch fire. A battery or other explosive material in or adjacent to the MEWP has caused an explosion. Electrical short and burnout.
Loss of stability of the MEWP, so that the MEWP has overturned or partially overturned. A MEWP classed as partially overturned will be resting on an external structure or not have all the necessary ground points in contact with the ground.
The MEWP has fallen or tipped over during loading or unloading on to the transport vehicle.
Safety equipment including clothing, fall protection harness and lanyard
For example signs, machine guards and supports were not used or in place. Manoeuvring the machine on inadequate ground. Machine placed in an unsafe configuration or position.
The MEWP is inoperable or cannot be used safely owing to mechanical breakdown or failure of technical/pre-use inspection.
Description of the incident and investigation.

“Please do not include personal, or identifiable, data such as’’:
Contact details
Date of Birth / Age
IPAF Licence Number

Note: *Further examples of what is classed as personal data can be found in the ICO website
Briefly describe the changes you have made.

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