PSU OPP Safety Incident Investigation Form

This incident investigation form is designed for Penn State University Office of Physical Plant to document accidents and near-misses. It captures employee details, department and work group, job role and shift, date and time of the event, and whether the safety office was notified within 24 hours. The form guides investigators to record a narrative of the incident, tasks being performed, affected body part, type of injury, environmental conditions, PPE requirements and usage, witness information, and property damage. It includes comprehensive checklists for immediate and root causes, such as unsafe procedures, lack of training, equipment issues, and environmental factors. The final section focuses on corrective actions, engineering controls, remedial training, and follow-up work orders, with fields for investigator and reviewer sign-off and completion date.