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INCIDENT REPORT FORM
If you wish to claim for an incident which has caused loss or damage to your property, and/or
personal injury, you should complete and return this form.
• Please use capital letters and complete all relevant sections.
• Failure to complete any mandatory field (marked with an asterisk *) may delay the
processing of your claim.
Completion of this form should not be construed as an admission of liability on the part of the
council, or that you will automatically receive compensation. All information is requested in order
to comply with the protocols laid down in the Civil Justice Reforms 1999 (Woolf Reforms).
Please return this completed form to:-
Insurance Section or insurance@enfield.gov.uk
PO Box 54
Civic Centre
Silver Street
Enfield
EN1 3XF
DETAILS OF INCIDENT
Date of incident* _______/________/________ Time: __________________ am / pm
Exact location of incident *
PLEASE NOTE - You are required to precisely identify the incident location before we can formally
consider your claim
Full details of incident – how did the incident occur?*
