The Incident Investigation Form is a critical document used to comply with U.S. workplace safety regulations and document organizational responses to workplace incidents. This form is required whenever an accident, near-miss, or safety incident occurs in the workplace, serving as both a legal record and an analytical tool. It must comply with OSHA standards (29 CFR Part 1904) for recording and reporting occupational injuries and illnesses, while also considering state-specific requirements and industry standards. The form captures essential information about the incident, including witness statements, root cause analysis, and corrective actions, making it valuable for prevention efforts and potential legal proceedings. Organizations use this document to demonstrate due diligence in investigating incidents and implementing preventive measures.
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1. Incident Information: Basic details including date, time, location, and type of incident
2. Affected Parties: Information about all individuals involved in or affected by the incident, including witnesses
3. Incident Description: Detailed narrative of what occurred, including sequence of events
4. Immediate Actions Taken: Emergency response measures and immediate steps taken following the incident
5. Investigation Details: Methods used to investigate, evidence collected, and findings
6. Root Cause Analysis: Identification and analysis of the fundamental causes of the incident
7. Contributing Factors: Secondary factors that may have influenced the incident occurrence
8. Injuries/Damages Assessment: Detailed description of any injuries to persons or damage to property
9. Corrective Actions: Specific measures to be implemented to prevent recurrence
10. Review and Authorization: Signatures of investigator, supervisor, and relevant authorities
1. Environmental Impact: Assessment of environmental effects when incident involves spills, emissions, or other environmental concerns
2. Equipment/Machinery Involvement: Detailed analysis of equipment failure or machinery involvement in the incident
3. Vehicle Incident Details: Specific information for incidents involving vehicles, including vehicle data and driver information
4. Chemical Exposure: Details of chemical involvement, including substance information and exposure assessment
5. Security Breach: Information related to security violations or unauthorized access
6. Cost Analysis: Breakdown of costs associated with the incident, including property damage and business interruption
7. Media/Public Relations: Communication strategy and public relations response for significant incidents
8. Regulatory Reporting: Documentation of notifications made to regulatory bodies and compliance requirements
1. Appendix A - Witness Statements: Standard forms and collected statements from witnesses
2. Appendix B - Photographic Evidence: Photos, videos, or other visual documentation of the incident scene
3. Appendix C - Scene Diagrams: Sketches, floor plans, or diagrams showing incident location and relevant details
4. Appendix D - Risk Assessment Matrix: Tool for evaluating the severity and likelihood of similar incidents
5. Appendix E - Equipment Inspection Records: Relevant maintenance and inspection records for involved equipment
6. Appendix F - Training Records: Documentation of relevant training for involved personnel
7. Appendix G - Investigation Checklist: Standardized checklist ensuring all investigation steps are completed
8. Appendix H - Incident Classification Guide: Reference guide for categorizing incident type and severity
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