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Accident Investigation Report Template

A structured template for conducting thorough investigations of workplace accidents, incidents, and near-misses to identify causes and prevent future occurrences.

Accident Investigation Report Template

by: audit-now
4.2

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About This Checklist

An Accident Investigation Report Template is a crucial tool for ensuring thorough and systematic analysis of workplace incidents. This comprehensive checklist guides investigators through the process of gathering essential information, identifying root causes, and developing effective preventive measures. By utilizing this template, organizations can improve their safety protocols, reduce the likelihood of future accidents, and demonstrate their commitment to maintaining a safe work environment. Implementing a standardized accident investigation process not only helps in legal compliance but also contributes to creating a culture of safety awareness among employees.

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Industry

Safety and Risk Management

Standard

OSHA Recordkeeping Requirements

Workspaces

Factory
Warehouse
Laboratory
Construction Sites
Office Buildings

Occupations

Safety Manager
Occupational Health Specialist
Risk Management Professional
Human Resources Manager
Operations Supervisor
1
What is the incident report number for this investigation?
2
Was the root cause of the incident identified?
3
How many days did it take to resolve the incident?
Min: 0
Max: 365
4
What preventive measures have been implemented following the incident?
5
Was the incident reviewed for OSHA compliance?
6
What is the date of completion for the investigation?
7
Was the incident reviewed by a safety officer?
8
Have all relevant witness statements been collected?
9
What was the total cost incurred due to the incident?
Min: 0
Max: 1000000
10
Was safety training provided to employees after the incident?
11
Provide a summary of the incident analysis.
12
What was the date of the incident?
13
Are any follow-up actions required based on the investigation findings?
14
Was the emergency protocol activated during the incident?
15
Please list the names of individuals who were injured in the incident.
16
Was the investigation conducted by a designated investigation team?
17
Describe the environmental conditions at the time of the incident.
18
How many safety violations were identified during the investigation?
Min: 0
Max: 100
19
When was the safety review meeting held to discuss the incident?
20
Has the insurance provider been notified about the incident?
21
Was management informed about the incident and its findings?
22
Please provide a detailed description of the accident.
23
At what hour did the incident occur?
Min: 0
Max: 24
24
Did the injured parties require medical attention?
25
Were all required safety gear and equipment worn during the incident?
26
When was the incident reported?
27
Have corrective actions been implemented to prevent future incidents?
28
Please provide any follow-up recommendations based on the investigation findings.
29
What equipment was involved in the incident?
30
On a scale from 1 to 10, how severe were the injuries sustained?
Min: 1
Max: 10
31
Was the incident related to a violation of safety regulations?
32
Was appropriate personal protective equipment available at the time of the incident?
33
When was the last safety training conducted before the incident?
34
Has an action plan been developed following the investigation?
35
What lessons were learned from this incident?

FAQs

This template should be used immediately following any workplace accident, incident, or near-miss event to ensure all relevant information is captured while it's still fresh.

Typically, a designated safety officer, supervisor, or trained investigator is responsible for completing the report, often in collaboration with witnesses and involved parties.

The report should include details such as the date, time, and location of the incident, involved parties, witness statements, description of the event, immediate and root causes, and recommended corrective actions.

By systematically analyzing accidents, the template helps identify trends, underlying causes, and areas for improvement in safety protocols, leading to more effective preventive measures and a safer work environment.

Yes, while the core elements remain consistent, the template can be customized to include industry-specific factors, hazards, and regulatory requirements relevant to the particular workplace.

Benefits of Accident Investigation Report Template

Ensures a systematic and thorough approach to accident investigations

Helps identify root causes and contributing factors to prevent future incidents

Facilitates consistent reporting and documentation of accidents across the organization

Supports compliance with safety regulations and standards

Aids in developing effective corrective actions and safety improvements