Forms

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AsbestosNotification form to be used for any work involving asbestos(doc, 53KB)
Biological Agents

Form for Reporting a case of disease or death from occupational exposure to a biological agent

The above form can be used to report a case of disease or death from occupational exposure to a biological agent.

Note: This form should be used to report cases of COVID 19 or deaths resulting from COVID 19 in employees resulting from occupational exposure to the SAR-CoV-2 virus.

Form of Notification for First Time Use of a Group 2/3 or 4 Biological Agent

The above form is to be used by laboratories to notify the Authority of first time use of a Group 2, 3 or 4 biological agent.

(doc, 63KB)

 

COMAH Notifiable Incident

COMAH notifiable incidents should be reported by completing the Notifiable Incident Notification Form and sending it by email to comah@hsa.ie

Please note that this form is not to be used for general accident and dangerous occurrence reporting - see our online accident reporting below for information on reporting accidents and dangerous occurrences.

(pdf, 79KB)
Complaint

Whether you’re an employee, a safety representative or a member of the public, you can use this form to make a complaint in relation to a workplace occupational safety, health or welfare issue

Online complaint form
ConstructionApproved Form (AF 1) - Particulars to be notified by the Client to the HSA before the design process begins(pdf, 29KB)
 Approved Form (AF 2) - Particulars to be notified by Project Supervisor for the Construction Stage to the Health and Safety Authority before the construction work begins Report AF2 online
 Approved Form (AF3) - Thorough Examination of: (a) Excavations, Shafts, Earthworks, Underground Works or Tunnels; (b) Cofferdams or Caissons(pdf,520KB)
 Approved Form (AF4) - Results of Inspection & Thorough Examination of Personal Flotation Devices(pdf, 555KB)
Dangerous OccurrencesDangerous occurrences should be reported using the Authority’s online reporting system.
Lifting Equipment

Form GA1 - Report of Thorough Examination

(pdf, 120KB)

 

Form GA2 - Report of Weekly Examination

(pdf, 140KB)

Work at Height

Form GA3 - Inspection of Work Equipment for Working at Height Form

GA3 - Scaffold Specific Inspection Form

(pdf, 369KB)

(pdf, 576KB)

Report an Accident (IR1)Accidents can be reported to the Health and Safety Authority in two ways, namely by hard copy, i.e. completing the Incident Report Form (IR1) and posting it to the HSA Contact Centre, Health and Safety Authority, The Metropolitan Building , James Joyce Street, Dublin 1, or reporting online, via the Health and Safety Authority's website.IR1 online
QuarriesNotification Form(pdf) 17.1 KB)