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Accident and Illness Investigation Report Template

by Felipe Rodriguez, from the Community

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Use this CBIZ BP Loss Control Accident and Illness Investigation Report template to document and investigate workplace incidents. Record employer and employee details, healthcare provider information, incident time and location, injury type, and OSHA-notification notes. Capture narratives of what happened, affected body parts, and direct causes. Log witness statements and contact details. Verify PPE, guarding, training, and lockout procedures. Determine root cause, assign corrective and preventive actions, attach photos and diagrams, and obtain supervisor approval to prevent recurrence.

With SafetyCulture you can

Digitize any process, procedure or policy
Eliminate mistakes made by paper-based processes
Create and share professional reports instantly
Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy
Eliminate mistakes made by paper-based processes
Create and share professional reports instantly
Confirm accountability and compliance with a digital log

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Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.