1. Name, address and telephone number of the person submitting the notice and, if different, corresponding particulars of the person to whom enquiries should he addressed.
2. Date on which the notice is submitted.
3. Supplier’s reference and sequential reference number.
4. Site of the event:
(a)address;
(b)location within the premises.
5. Date of event.
6. Person involved in the event—
(a)surname and initials of the deceased person;
(b)if at work, type of work;
(c)if not at work, sufficient description to identify status, e.g. householder, visitor, child;
(d)age;
(e)sex;
(f)nature of injury and cause of death.
7. Inquest verdict or fatal accident inquiry findings.
8. Equipment involved in the event—
(a)apparatus directly involved—
(i)type and make;
(ii)whether it was faulty;
(iii)if electric blanket, whether over or under blanket;
(iv)if radiator, whether it was guarded;
(b)whether the death was due to a fault involving—
(i)fixed wiring;
(ii)flexible lead;
(iii)appliance lead;
(iv)appliance;
(v)plug;
(vi)socket outlet;
(vii)misuse of equipment or appliance;
(viii)bare wires;
(ix)taped joints;
(x)broken neutral;
(xi)exposed and live male plug pins.
9. Supply installation details—
(a)voltage;
(b)earthing arrangements, whether—
(i)the earthing connection was loose;
(ii)the earthing connection was disconnected;
(iii)the earthing connection was in contact with a phase conductor in the plug, the socket or elsewhere, and, if so, where;
(iv)the earthing connection was to a water pipe, local earth electrode, cable sheath, aerial earthwire or earthing terminal and, if so, which;
(v)the earth fault loop impedance was measured and, if so, the measurement obtained;
(c)description of circuit protection;
(d)extent of operation of circuit protection.
10. Whether there was evidence of amateur work.