Template

OSEA Accident Investigation Report

by Joe Coniglio, from the Community

10+

Use this OSEA Accident Investigation Report template to systematically document workplace incidents. Capture site and personnel details, date and time, exact location, job role, and nature of injury. Record witness statements and the injured party’s account, assess severity and OSHA recordability, and note immediate medical treatment. Identify contributing factors and root causes such as inadequate training, supervision, or PPE. Verify if a risk assessment was completed, log corrective actions (short and long term) with responsible parties, and document investigation conclusions and approvals. Designed for manufacturing and shop-floor environments including rollfeed, powerpress, toolroom, plating shop, and more.

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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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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.

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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Template
Incident and Accident Investigation Template
This incident and accident investigation template helps teams document workplace incidents thoroughly. Capture investigation details, incident type, injured person information, date and time, and affected body parts. Record tasks being performed, training status, a detailed narrative of events, images, and all witnesses. Track medical treatment and outcomes, including first aid provided and follow-up care. Gather signed witness statements. Identify causes and contributing factors such as machine or electrical faults, PPE use, training, and housekeeping. Plan immediate corrective actions and longer term preventive measures, assign ownership and timelines, and note reportability and time off. Conclude with results, damaged equipment, and authorizations.
by Ed Coleman, from the Community
Downloads: 10+
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Template
Accident Investigation Form
This accident investigation form helps construction teams document workplace incidents thoroughly and consistently. Record incident details, location, date and time, weather conditions, and photos. Capture involved employee information, witness details, and training status. Verify JHA availability and compliance, note pre-task checklist completion, and identify causes, contributing factors, and any safety violations. Summarize findings and assign corrective actions with responsible persons, due dates, and signatures. Designed to support root cause analysis and continuous improvement across job sites.
by Joe Schemonia, from the Community
Downloads: 0
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OSEA Accident Investigation Report

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