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Accident/Incident Investigation Report

Author: Novade Solutions

Document & analyze incidents effectively, enabling detailed reporting, root cause identification, and actionable insights to enhance workplace safety

Published on: 1/24/2025

Accident/Incident Investigation Report

General Information

Company name

Location

Contract no.

Report title

Report date

Accident date

Accident ref.

Initial report

Final report

General location of accident/incident

Other

Date of accident

Time

Injured person’s name

Occupation

Address

Employer

Supervisor

Site manager

First aider

Injury

Treatment administered (on or off site)

Witness & Employer

S/N	Witness	Employer
-	-	-

Edit Table

Photo Documentation

Incident classification (indicate appropriate category)

Previous experience/training of injured person

Relevant training details

Other (specify)

Date of induction

Date of last relevant awareness talk(s)

Supporting information availableDigital photographs must have the correct level of validation (date, independent witness, etc.)

Supporting information available

Other (state below)

Photo

Date

Time

Background information (in date/time order, to include – start dates, previous works, contract progress,work group personnel, adjacent trades, nature of work being undertaken, etc.)

Date

Time

Summary of accident (in date/time order, description of the incident including location, personnel involved, activity being carried out, equipment involved, permits to work, sitedrawings and working conditions. Record timeline of events)

Immediate action taken (emergency plan, first aid, site secured, hospital, contacts made, prevention of further loss)

Distribution

Name

Position

Telephone

Dist.

Accident/incident investigation report (Part 2)

Immediate cause of accident (consider all factors, including temperature, weather, system failure, design failure, equipmentfailure, poor housekeeping, human error and the influence of alcohol or drugs)

Root cause of accident (consider issues, such as lack of training and awareness, time constraints, communicationand external influences)

Remedial action

Conclusion and recommendations (analysis of evidence, comparison with standards, highlight the main issues,who is responsible, and so on)

Recommendations

Immediate

Interim

Long-term

Learning opportunities and responsibilities

Person responsible

Action

Target date

Close-out date

Signature

Communication of learning

Other (state)

Appendices

Other report forms

Witness statements

Photograph index sheet and photographs

Drawings

Training/control

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Accident/Incident Investigation Report

General Information

Company name

Location

Contract no.

Report title

Report date

Accident date

Accident ref.

Initial report

Final report

General location of accident/incident

Other

Date of accident

Time

Injured person’s name

Occupation

Address

Employer

Supervisor

Site manager

First aider

Injury

Treatment administered (on or off site)

Witness & Employer

S/N	Witness	Employer
-	-	-

+ Add New Row

Photo Documentation

Incident classification (indicate appropriate category)

Previous experience/training of injured person

Relevant training details

Other (specify)

Date of induction

Date of last relevant awareness talk(s)

Supporting information availableDigital photographs must have the correct level of validation (date, independent witness, etc.)

Supporting information available

Other (state below)

Photo

Date

Time

Background information (in date/time order, to include – start dates, previous works, contract progress,work group personnel, adjacent trades, nature of work being undertaken, etc.)

Date

Time

Immediate action taken (emergency plan, first aid, site secured, hospital, contacts made, prevention of further loss)

Distribution

Name

Position

Telephone

Dist.

Accident/incident investigation report (Part 2)

Root cause of accident (consider issues, such as lack of training and awareness, time constraints, communicationand external influences)

Remedial action

Conclusion and recommendations (analysis of evidence, comparison with standards, highlight the main issues,who is responsible, and so on)

Recommendations

Immediate

Interim

Long-term

Learning opportunities and responsibilities

Person responsible

Action

Target date

Close-out date

Signature

Communication of learning

Other (state)

Appendices

Other report forms

Witness statements

Photograph index sheet and photographs

Drawings

Training/control

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