incident investigation form

The report is quite detailed and will allow the manager to include incidents, delays, tardiness, safety and lost items. If yes, review the JHA, answer the following questions, and attach a copy to this report. 0000018989 00000 n Use this 0000021133 00000 n WHS FORM 10: INCIDENT AND INJURY REPORT Details of injury (eg to a worker or visitor) and treatment Date of incident. Are there particular types of hazards you had in mind?The write up is highly expository and a must for all incident investigators to have. Clinical diagnosis is also not as straightforward as many assume.

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You may already be familiar with this, but if not, it’s a simple exercise that helps to identify the root cause of an incident. When a shortcoming is identified, it is important to ask why it existed and why it was not previously addressed.These examples illustrate that it is essential to discover and correct all the factors contributing to an incident, which nearly always involve equipment, procedural, training, and other safety and health program deficiencie.Addressing underlying or root causes is necessary to truly understand why an incident occurred, to develop truly effective corrective actions, and to minimize or eliminate serious consequences from similar future incidents.To assist employers and workers in conducting effective incident investigations, and to develop corrective action plans, the following resources can help:Occupational Safety and Health Administration.The Department of Labor does not endorse, takes no responsibility for, and exercises no control over the linked organization or its views, or contents, nor does it vouch for the accuracy or accessibility of the information contained on the destination server. Workplace accident/incident investigation template No deadline? When someone dies at work.A physical injury, such as a bump on the head or a broken arm.A sickness, such as a respiratory illness suffered from inhaling chemical fumes.Damage to property, such as crashing a forklift into a shelving unit and damaging the forklift and shelving.Releasing something into the environment that should not have been released, such as a toxic leak into a stream.Something that could have resulted in a fatality, injury, illness, and/or property damage, but didn’t. With the JotForm builder, your report templates have access to widgets, apps, and themes to encourage engagement and improve the amount of information collected. Start building your form today by starting off with our daily management report.Receive maintenance requests online with a free Maintenance Request Form. Is an employee representative to be included? Documents.

endstream endobj 141 0 obj <>/Subtype/Form>>stream Do you have a plan in place right now?

Thank you for visiting our site. Particulars of Accident Date of accident: DD / MM / YEAR Time: Location: Date reported: DD / MM / YEAR 2. endstream endobj 139 0 obj <>/Subtype/Form>>stream H‰Ò©PpòuVàr Keep an electronic copy and save it in some logical place on your computer or the work network so you can access this later, print more copies, and/or modify it as necessary.Once you’ve finished with the forms to lead investigators through the interview process, create a similar form to lead investigators through the rest of the investigation. endstream endobj 145 0 obj <>/Subtype/Form>>stream Thanks for leaving the comment.I guess ideally, it would be great if you had a team so you could divide and conquer, delegating responsibilities to some and other responsibilities to others.And I guess in some cases, you can take the order of those two steps on a case-by-case basis.But I think you’re right that in some cases, even if the scene is barricaded, evidence could change due to things like the natural forces you’re talking about (something evaporates, etc.

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