Ddigwyddiad)

Hoffech chi gwblhau'r ffurflen hon yn Gymraeg neu'n Saesneg? / Do you want to complete this form in Welsh or English?
Purpose of the form

This form is to be used to notify accidents and incidents. Please complete all sections but only include information you know to be correct. Do not state opinions or include names or other information you do not know to have been involved.
Pwrpas y ffurflen

Mae'r ffurflen hon i'w defnyddio i hysbysu damweiniau a digwyddiadau. Cwblhewch bob adran gan ddim ond cynnwys gwybodaeth sy'n hollol gywir. Peidiwch a cynnwys eich barn bersonol, na chofnodi enwau nac unrhyw wybodaeth arall sydd ddim yn berthnasol.
Type of Incident

This helps you understand the information
Math o Ddigwyddiad
H&S Incident Sub-Type
Digwyddiad I&D Is-Fath *
Property Incident Sub-Type
Digwyddiad Eiddo Is-Fath *
Security Incident Sub-Type
Digwyddiad Diogelwch Is-Fath *
Environmental Incident Sub-Type
Digwyddiad Amgylcheddol Is-Fath *
Person Making the Report
Person sy'n gwneud yr adroddiad
Your Name
Eich Enw
Your Telephone No:
Eich Rhif Ffôn
Your Email
Eich E-bost
In which part of the University do you work?
Ym mha adran or Brifysgol ydych chi'n gweithio?
Line Manager Name
Enw rheolwr llinell
Line Manager Email
E-bost rheolwr llinell
Incident Details
Manylion Digwyddiad
Date of Incident Date of Incident / DD / MM YYYY
Dyddiad y Digwyddiad Dyddiad y Digwyddiad / DD / MM YYYY
Time Time : HH MM
Amser Amser : HH MM
In which location did it occur?
Ble oedd lleoliad y digwyddiad?
Location Details:
Please be specific to include building name / room number or off campus / other location:
Manylion am y lleoliad:
Byddwch yn fanwl e.e / enw adeilad / rhif ystafell / ar neu i ffwrdd or campws / lleoliad arall
Provide a description of what happened:
Rhowch ddisgrifiad o'r hyn a ddigwyddodd
Were the Emergency Services called?
Cafwyd y gwasanaethau brys eu galw?
Which Emergency Service(s) attended?

Which Emergency Service(s) attended? Police Paramedic Fire
Pa wasanaeth(au) brys fynychodd?

Pa wasanaeth(au) brys fynychodd? Heddlu Ambiwlans Gwasanaethau Tân
Does a "Cause for Concern" form need to be submitted in relation to Student Welfare?
A oes angen cyflwyno ffurflen "Achos Pryder" mewn perthynas â Lles Myfyrwyr?
Injured Person Details
List here all persons injured if relevant
Manylion y person a anafwyd
Rhestrwch yma bob person a anafwyd os yw'n berthnasol
Has anyone been injured?
Cafodd unrhywun ei anafu?
Injured party details
Manylion y sawl a anafwyd
Injured Party 1 Name
Enw'r person gafodd anaf
Injured Party 1 Telephone (if known)
Rhif ffôn y person gafodd anaf (os yn gwybod)
Injured Party 1 Email (if known)
E-bost y person gafodd anaf (os yn gwybod)
Injured Party Line Manager Name
Injured Party Line Manager Email (if known)
Injured Party 2 Name
Enw y person gafodd anaf 2
Injured Party 2 Telephone (if known)
Rhif ffôn y person gafodd anaf 2
Injured Party 2 Email (if known)
E-bost y person gafodd anaf 2
Other Injured Party Name & Contact Details (if known)
Enw a manylion cyswllt unrhyw berson arall gafodd anaf (os yn gwybod)
Provide brief details of injuries
Rhowch braslun o'u hanafiadau
Was any First Aid provided?
A roddwyd Cymorth Cyntaf?
First Aid details:
Provide name of First Aider and First Aid provided
Manylion Cymorth Cyntaf:
Enw'r person roddodd Cymorth Cyntaf a'r math a ddarparodd
Other Involved Persons Details
Manylion unrhyw berson arall oedd yno
How many involved persons do you wish to add?
Sawl person arall hoffech ychwanegu?
Involved Person 1 Name
Enw person arall 1
Involved Person 1 Role
Rôl person arall 1
Involved Person 1 Phone
Rhif ffôn person arall 1
Involved Person 1 Email
E-bost person arall 1
How was Person 1 involved in the incident?
Include details such as whether the incident was about the individual, they were a witness or helped resolve the incident.
Sut oedd person 1 yn rhan o'r digwyddiad? Cofnodwch manylion megys - oedd y person yn dyst i'r digwyddiad neu yn help i ddatrys y broblem
Involved Person 2 Name
Enw person arall 2
Involved Person 2 Role
Rôl person arall 2
Involved Person 2 Phone
Rhif ffôn person arall 2
Involved Person 2 Email
E-bost person arall 2
How was Person 2 involved in the incident?
Include details such as whether the incident was about the individual, they were a witness or helped resolve the incident.
Sut oedd person 2 yn rhan o'r digwyddiad? Cofnodwch manylion megys - oedd y person yn dyst i'r digwyddiad neu yn help i ddatrys y broblem
Involved Person 3 Name
Enw person arall 3
Involved Person 3 Role
Rôl person arall 3
Involved Person 3 Phone
Rhif ffôn person arall 3
Involved Person 3 Email
E-bost person arall 3
How was Person 3 involved in the incident?
Include details such as whether the incident was about the individual, they were a witness or helped resolve the incident.
Sut oedd person 3 yn rhan o'r digwyddiad? Cofnodwch manylion megys - oedd y person yn dyst i'r digwyddiad neu yn help i ddatrys y broblem
Other Involved Persons Name & Contact Details
Enw a manylion cyswllt unrhyw berson arall
Immediate Actions Taken
Camau uniongyrchol a gymerwyd
Following the incident what immediate actions have been taken?
Yn dilyn y digwyddiad, pa gamau a gymerwyd ar unwaith?

Accident / Incident Report Form (Ffurflen adrodd ar Ddamwain / Ddigwyddiad)

Accident / Incident Report Form (Ffurflen adrodd ar Ddamwain / Ddigwyddiad)

Purpose of the form

Pwrpas y ffurflen

Person Making the Report

Person sy'n gwneud yr adroddiad

Incident Details

Manylion Digwyddiad

Injured Person Details List here all persons injured if relevant

Manylion y person a anafwyd Rhestrwch yma bob person a anafwyd os yw'n berthnasol

Injured party details

Manylion y sawl a anafwyd

Other Involved Persons Details

Manylion unrhyw berson arall oedd yno

Immediate Actions Taken

Camau uniongyrchol a gymerwyd

Injured Person Details
List here all persons injured if relevant

Manylion y person a anafwyd
Rhestrwch yma bob person a anafwyd os yw'n berthnasol