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INJURY×INCIDENT INVESTIGATION FORM Date of Incident: Date Reported: Time: am×pm Name of person reporting the incident×hazard: Type of Accident: Minor Injury Major Injury Illness Dangerous Event×Near

How to fill out injuryincident investigation form

1. Start by gathering all relevant information about the injury or incident, such as the date, time, and location, as well as the individuals involved.
2. Begin filling out the form by providing your personal details, such as your name, job title, and contact information. This information may be required in case further investigation is needed.
3. Next, provide a detailed description of the injury or incident. Include any relevant information about the circumstances surrounding the event, what led up to it, and any witnesses present.
4. If there were any contributing factors or hazards that may have played a role in the incident, make sure to note them in the form. This can include things like slippery floors, malfunctioning equipment, or improperly stored materials.
5. If there were any actions taken immediately after the incident occurred, such as administering first aid or notifying a supervisor, document these steps in the form as well.
6. The form may also ask for information regarding the severity of the injury or damage caused. Be as accurate and detailed as possible when providing this information, as it can help determine the seriousness of the incident and any necessary interventions.
7. If there were any corrective actions taken to prevent similar incidents in the future, make sure to detail them in the form. This can include things like implementing new safety protocols, providing additional training, or fixing any identified hazards.
8. Finally, sign and date the form to indicate that the information provided is accurate and complete.

Who needs an injury incident investigation form?

An injury incident investigation form is typically needed by companies or organizations that prioritize workplace safety. Employers, supervisors, human resources personnel, and safety officers often use this form to investigate and document work-related injuries, accidents, or near misses. This form helps identify potential hazards, determine root causes, and implement preventative measures to improve overall workplace safety. It is an essential tool for maintaining compliance with safety regulations and improving the company's safety culture.

For pdfFiller’s FAQs

What is injuryincident investigation form?

The injury/incident investigation form is a document used to record details about accidents or injuries that occur in the workplace.

Who is required to file injuryincident investigation form?

Employers are required to file the injury/incident investigation form when an accident or injury occurs in the workplace.

How to fill out injuryincident investigation form?

The form should be filled out with details about the incident, including date, time, location, individuals involved, witnesses, and a description of what happened.

What is the purpose of injuryincident investigation form?

The purpose of the form is to investigate the causes of accidents or injuries in order to prevent similar incidents in the future.

What information must be reported on injuryincident investigation form?

Information such as date, time, location, individuals involved, witnesses, and a description of the incident must be reported on the form.

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