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City of Pittsburgh Incident Investigation Form (Sections 1, 2 &3 to be completed by person conducting investigation) CCR#: SECTION 1 Name of Injured: Employee Number: Dept./Location where injury occurred:
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How to fill out incident investigation form 2-1-17
How to fill out incident investigation form 2-1-17
01
Step 1: Start by entering the date of the incident in the designated field.
02
Step 2: Provide detailed information about the incident, including the time, location, and nature of the event.
03
Step 3: Identify any individuals involved in the incident, including witnesses and those directly affected.
04
Step 4: Describe the sequence of events leading up to and following the incident, including any contributing factors.
05
Step 5: Assess the impact of the incident, such as injuries, property damage, or business interruption.
06
Step 6: Determine the immediate actions taken to address the incident and prevent further harm.
07
Step 7: Analyze the root causes of the incident and identify any underlying issues or deficiencies.
08
Step 8: Develop and implement corrective actions to prevent similar incidents from occurring in the future.
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Step 9: Review and revise the incident investigation form based on feedback and improvements.
Who needs incident investigation form 2-1-17?
01
Anyone who wants to properly document and investigate an incident should use the incident investigation form 2-1-17.
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