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Incident Investigation Safety & Risk Management This form is for record keeping and loss control purposes. Return this form to Safety & Risk Management via electronic mail, fax or campus mail: to
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How to fill out incident investigation form

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How to fill out an incident investigation form:

01
Begin by gathering all relevant information pertaining to the incident, such as the date, time, and location of the incident, as well as the names of any individuals involved or affected.
02
Clearly state the nature of the incident and provide a detailed description of what occurred. Include any contributing factors or potential causes that may have led to the incident.
03
Document the extent of any injuries, damages, or losses resulting from the incident. Include any medical reports, witness statements, or photographs that may support your findings.
04
Identify any immediate corrective actions that were taken to address the incident or mitigate further risks. This may include implementing safety measures, conducting training sessions, or issuing warnings or reprimands.
05
Determine any underlying root causes that may have contributed to the incident. This could involve examining workplace conditions, equipment failures, or human factors. Consider using an incident investigation model such as the "5 Whys" or "Fishbone Diagram" to assist in identifying these root causes.
06
Develop and implement a comprehensive action plan to prevent future incidents from occurring. This may involve making changes to policies, procedures, or practices within the organization. Assign responsibility for each action item and establish a timeline for completion.
07
Review and finalize the incident investigation form, ensuring that all relevant sections have been completed accurately and comprehensively. Obtain any required signatures or approvals.

Who needs an incident investigation form:

01
Employers or business owners who are responsible for the safety and well-being of their employees and customers.
02
Safety managers or officers who are tasked with conducting incident investigations and implementing corrective actions.
03
Regulatory agencies or authorities who require incident reports to ensure compliance with safety regulations.
It is important to note that the need for an incident investigation form may vary depending on the industry, jurisdiction, and specific circumstances surrounding the incident.
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An incident investigation form is a document used to record and analyze details of an incident or accident that occurred in the workplace.
Employers are required to file incident investigation forms to comply with health and safety regulations in the workplace.
To fill out an incident investigation form, one must provide details such as date and time of incident, nature of incident, individuals involved, and any contributing factors.
The purpose of an incident investigation form is to identify the root causes of an incident, implement corrective actions, and prevent future occurrences.
Information such as date and time of incident, location, individuals involved, witness statements, and contributing factors must be reported on the incident investigation form.
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