Appendix 2 – Sample NPA01 form NON-POLICE AGENCIES (Notification of Proceedings to Police) AGENCY NAME: HEALTH & SAFETY EXECUTIVE AGENCY REF. No: [COIN case no] ADDRESS: [insert local office address] number] : [insert local office contact OFFICER IN CHARGE OF CASE: [Litigation Officer] SIGNATURE:________________________ For Police Use Only A/S Reference Number PNC Court Case Reference Number The NPPA will document this for Bichard 7 Solution PNC ID Number CRO Number Entered on PNC by Date Name Charged/Summonsed Surname Forename(s) Alias Name(s) Nickname Date of Birth Sex M Colour F Place of Birth Reported Photograph Taken DNA Sample Prosecuting Agents White Taken Arrested Non White British Nationality Process Stage Height (Imperial) Summoned X Time Date Fingerprints Mouth m in Driver Number Not Taken Not Taken ft or Metric Hair Taken Not Taken ID Number Health and Safety Executive Offence (in plain language, include Act & Section of Offence.) [insert offence wording from table – eg “Employer breaching general duty to employee, s33(1)(a) & 2 Health and Safety at Work etc Act 1974”] Offence Start Date/Time Offence End Date/Time Address/Location of Offence County Postcode Method used in Offence (Show as much information as possible especially in regards to words spoken/weapons used/means of entry/exit and part played by any ACCOMPLICE showing name and address where known.) [Base upon the allegation in the information, amending where necessary to aid third-party understanding] ***** FOR ADDITIONAL OFFENCE(S) USE A SEPARATE FORM NPA 02 Continuation form(s) NPA 02 attached Charged/Summonsed on date Yes Court Date ***** No Time Court Name Cautioned on date Cautioning Officer Rank Surname Name Cautioned Ethnic Appearance Forename(s) White Europea n Dark European Afro Caribbean Asian Oriental Arab Unknown Fat Heavy Stocky Broad Thin Slim Small Grey Hazel Pink Unknown Right Handed Left Handed Ambidextrous Build Medium Proportionate or Shoe Size Eye Colour(s) Blue Brown Green Glasses Glasses Contact Lenses Neither Type Colour (1) Handed Dyed/Greyin Colour (2) Features Hair Bald Collar Length Cropped Receding Short Shoulder L’th Very Long (BA) (CL) (CR) (RE) (SH) (SL) (VL) Moustache Beard Long Sideburns Clean Shaven (M) (B) Black White Light Brown Dark Brown Fair Blonde Ginger Auburn Grey Brown Red Sandy Mousey (BK) (WH) (LB) (DB) (FA) (BD) (GI) (AU) (GY) (BR) (RD) (SA) (MO) Dyed Greying (D) (G) Black White Light Brown Dark Brown Fair Blonde Ginger Auburn Grey Brown Red Sandy Mousey Blue Green Orange Purple Yellow Pink Multi (L) (C) Type Colour (1) Dyed/Greyin (BK) (WH) (LB) (DB) (FA) (BD) (GI) (AU) (GY) (BR) (RD) (SA) (MO) (BL) (GN) (OR) (PU) (YE) (PI) (MU) Colour (2) Afro Plaited Mohican Beehive Ponytail Punk Rasta Shaven Skinhead Teddy Permed Curly Wavy Dirty Greasy Streaked Thinning Wig Straight Untidy (AF) (PL) (MO) (BH) (PT) (PK) (RA) (SV) (SK) (TE) (PM) (CU) (WA) (DI) (GR) (SD) (TH) (WI) (ST) (UT) Features Facial Hair Accent English North West Liverpool American West Indian Marks/Scars/ Abnormalities Scottish Yorkshire Birmingham Australian Asian TATT MARK LACK SCAR PRCD PECU Tattoo Lacking Scarred Pierced Peculiar Irish Midland London French Oriental R L C U W Welsh East Anglia Glasgow German Foreign Other Right Left Centre Upper Lower SCAL(Scalp) EYES LIPS NECK BACK ARMS Northern West Country North East Southern Italian Cultured Spanish LEGS GAIT BROW EARS TEET(Teeth) CHES(Chest) GENI(Genitals HAND FEET SPEE(Speech FACE NOSE CHIN ABDO(Abdomen BUTT (Buttocks) FING (Finger) TOES TONG (Tongue) Description (describe tattoo or other details) Home Address(es) Other Address(es) Postcode [or registered address for companies] Postcode Type Number Identity Numbers (DSS/National Insurance etc.) Occupation Date Habitual Dress Jewellery Worn State if worn permanently and body position Habits/Mannerisms Special skills Bracelet Watch Brooch Pendant Earring Other Neck h i Pin Ring