The Incident Investigation Form is a crucial document required under Malaysian workplace safety regulations, specifically designed to comply with the Occupational Safety and Health Act 1994 and related DOSH guidelines. This form must be completed following any workplace incident, accident, or near-miss situation that could affect employee safety, property damage, or operational continuity. It serves multiple purposes: documenting the incident details, analyzing root causes, recording witness statements, outlining corrective actions, and maintaining compliance with Malaysian regulatory requirements. The form is essential for legal protection, insurance claims, and implementing preventive measures to avoid future incidents. It should be completed promptly after an incident occurs and requires input from various stakeholders including safety officers, department heads, and affected parties.
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1. Incident Basic Information: Date, time, location, and type of incident
2. Affected Persons: Details of injured/affected individuals, including employees, contractors, or members of public
3. Incident Description: Detailed narrative of what occurred, including sequence of events
4. Immediate Actions Taken: Emergency response measures and immediate actions taken after the incident
5. Witness Information: Details and statements from witnesses
6. Investigation Findings: Analysis of direct and root causes of the incident
7. Property/Equipment Damage: Description and extent of damage to property or equipment
8. Corrective Actions: Immediate and long-term corrective measures to prevent recurrence
9. Investigation Team: Details of personnel conducting the investigation
10. Sign-off and Verification: Signatures of investigating team, management review and approval
1. Environmental Impact Assessment: For incidents involving environmental damage or chemical spills
2. Medical Report Summary: For incidents involving serious injury requiring medical attention
3. Security Breach Details: For incidents involving security violations or unauthorized access
4. Production Impact Analysis: For incidents affecting production or operations
5. Third Party Involvement: For incidents involving contractors, vendors, or public
6. Regulatory Notification Details: For reportable incidents requiring authority notification
1. Photographic Evidence: Photographs of incident scene, damage, or relevant conditions
2. Witness Statements: Detailed written statements from witnesses
3. Technical Reports: Equipment inspection reports, maintenance records, or technical assessments
4. Medical Reports: Detailed medical reports and treatment records
5. Risk Assessment: Pre-incident risk assessments and post-incident review
6. Training Records: Relevant training records of involved personnel
7. Incident Scene Diagram: Sketches or diagrams of incident location and contributing factors
8. Previous Incident History: Records of similar incidents or near-misses
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