DfT home   Policy, guidance and research   Freight   Carriage of Dangerous Goods

Dangerous Goods incident reporting form

Please complete the form below:

An asterisk* indicates that the question is mandatory.

1. Your information
Organisation/Company name:*
Name*
Poatal address*
Post Code*
Email address*
Telephone
2. What mode of transport was being used when the incident occurred?*	Rail Road
3 What is the train wagon or vehicle registration? (optional)
4. What date did the incident occur?*
5. Where did the incident occur? Please select from the following:
For rail	Station Shunting/marshalling yard Loading/unloading/transhipment site
Please state location/country:
or Open line
Description of line:
Kilometres:
For Road	Built-up area Loading/unloading/transhipment site Open Road
Location of incident and Country:
6. Did the incident occur on a :*	Gradient/incline Tunnel Bridge/Underpass Crossing
7. Weather conditions at the time:*	Raining Snowing Ice Fog Thunderstorm Storm
Temperature ........0C (if known)
8. What was the type of incident?*	Derailment/Leaving the road Collision Overturning/Rolling over Fire Explosion Loss Technical fault
Additional information:
9. What dangerous goods were involved?
UN Number(1)*
Class: *
Packing group:*
Estimated quantity of loss of products (kg or l)
Means of containment:*	Please select... Packaging IBC Large packaging Small container Wagon Vehicle Tank wagon Tank-vehicle Battery-wagon Battery-vehicle Wagon with demountable tanks Demountable tank Large container Tank-container MEGC Portable tank
Type of failure of means of containment:*	Please select... Loss Fire Explosion Structural failure
10. What was the cause of the incident? (if clearly known)*	Technical fault Faulty load securing Operational cause (rail operation) Other: Please state below:
11. Were their any personal injuries in connection with the dangerous goods involved? * (If yes please answer q12 and q13 - otherwise please go to q14)	Yes No
12. Were there any fatalities?	Yes No
13. Were there any injuries?	Yes No
14. Was there a loss of product?*	Yes No Imminent risk of loss of product
15. What is the estimated material/environmental damage?*	Up to 50,000 Euros Over and above 50,000 Euros
16. Were there any emergency services or other authorities involved at the scene?*	Yes No
If yes please answer the following questions: 16a.Was there an evacuation of persons for a duration of at least three hours caused by the dangerous goods involved?	Yes No
16b. Were there any emergency services or other authorities involved at the scene?	Yes No