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This document provides a detailed investigation report of an incident where a laborer was electrocuted due to an antenna contacting an energized overhead power line while relocating a steel pole building.
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How to fill out MIFACE INVESTIGATION

01
Gather all necessary background information related to the workplace incident.
02
Complete the MIFACE Investigation form with detailed descriptions of the incident.
03
Include the date, time, and location of the incident.
04
Document the individuals involved in the incident, including witnesses.
05
Describe the circumstances leading up to the incident.
06
Record the sequence of events that occurred during the incident.
07
Note any safety equipment and protocols that were in place.
08
Identify immediate causes and potential underlying causes of the incident.
09
Review the information for accuracy and completeness.
10
Submit the completed form to the appropriate MIFACE office.

Who needs MIFACE INVESTIGATION?

01
Employers looking to improve workplace safety and prevent future incidents.
02
Workers who wish to report unsafe conditions.
03
Health and safety professionals involved in workplace safety assessments.
04
Regulatory agencies investigating workplace incidents.
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MIFACE (Michigan Fatality Assessment and Control Evaluation) Investigation is a program that investigates work-related fatalities in Michigan to identify risk factors and develop recommendations for preventing future incidents.
Employers who are involved in a work-related fatality are required to file a MIFACE Investigation. This typically includes workplace supervisors and safety officers.
To fill out a MIFACE Investigation, you need to provide details about the incident such as the circumstances leading to the fatality, the work environment, and any relevant safety measures in place at the time of the incident.
The purpose of MIFACE Investigation is to gather data on worker fatalities to improve workplace safety and prevent future accidents through analysis and recommendations.
Information that must be reported includes the date and location of the incident, details of the victim, circumstances of the incident, any witnessed accounts, and any safety protocols that were or were not followed.
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