Template

CPI Incident Investigation Template

by Mark Hueftle, from the Community

20+

Use this CPI Incident Investigation template to systematically document workplace incidents from initial report through corrective action. Capture employee details, status of injury, job role and tenure, training status, and whether a JSA was completed. Record the location, date and time, work phase, and nature of the incident, attach photos or media, and document facts discovered during the investigation. Identify contributing and root causes, assign corrective actions with owners and due dates, and collect signatures for accountability. Ideal for EHS teams across manufacturing and other industrial operations seeking a consistent, auditable process.

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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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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.

Template
Incident Investigation Report Template
This comprehensive incident investigation report template helps teams capture the facts, evidence, and outcomes of workplace incidents from start to finish. Record incident details and timelines, document weather conditions, log evidence with photos, and track vehicles, equipment, damages, and other items. Capture people involved, witness statements and signatures, and detailed injury information including type and affected body parts. Conduct a structured root cause analysis using contributing factors and five whys to identify underlying causes and likelihood of recurrence. Plan and verify corrective actions and recommendations, then finalize with investigator and reviewer sign-offs and follow-up assignments. Ideal for construction and field operations seeking a thorough, repeatable approach to incident documentation and prevention.
by Mark Baylis, from the Community
Downloads: 10+
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Template
Incident and Injury Investigation
Use this incident and injury investigation form to capture key incident details, determine root causes, and implement corrective actions. The checklist guides you from reporting and first aid through evidence gathering, cause analysis, and action planning, then evaluates effectiveness for continuous improvement. Ideal for supervisors and safety teams seeking a consistent, defensible process to reduce repeat incidents and improve workplace safety.
by Dave Renje, from the Community
Downloads: 0
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Template
Accident and Incident Investigation Report
This accident and incident investigation report template helps teams document workplace incidents thoroughly and consistently. Capture site details, principal contractor and employer information, timelines, supervision details, and whether a risk assessment was completed. Record the nature of the incident, causes and contributing factors, severity, notifications to HSE or client, and the injured party’s status. Include statements from the injured party and witnesses, medical treatment information, and both short- and long-term corrective actions. Attach photos, drawings, and training records, and finalize with investigation conclusions and required sign-offs.
by Graham Plumbe, from the Community
Downloads: 0
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Template
Accident Incident Report Template
Use this accident and incident report template to document workplace events from initial details to investigation. Record employee and site information, date and time, injury and body part, witnesses, medical treatment, severity and return to work status. Capture causes and contributing factors, corrective actions with responsible parties and due dates, and lessons learned. Include employee and witness statements and attach photos, drawings and training records to support the report.
by Steve Pope, from the Community
Downloads: 10+
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CPI Incident Investigation Template

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Incident Investigation Report Template

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Incident Investigation Report Template

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