SAGGA SASA ASDA EPSASA SABISA TPMA SAFIERA SASEMA AAAMSA Fenestration

Glass Incident Register

Glass Incident Register

All fields marked (*) are required

Contact Details of Person Submitting this Incident*

Contact Details of Injured Person*

Age of Injured Person*

Date and Time of Incident

Address where incident occurred *

Building Classification *

Glazing type causing incident *

Nature of Injury

Cause of Injury

Can we contact you regarding this incident? *

Yes -
No -

Can we use this info for training or presentation? *

Yes -
No -

Upload pictures or any other documentation - (if applicable)