Template

Accident, Incident or Near Miss investigation report

by Kirk Nicholson, from the Community

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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

Description

This comprehensive template provides a structured framework for documenting and investigating workplace accidents, incidents, and near-misses. It covers essential information including client details, worker involvement, witness accounts, injury documentation, and location specifics. The template guides users through collecting crucial data about the incident timeline, contributing factors, and necessary first aid responses. It emphasizes the importance of detailed documentation with provisions for photographic evidence and client verification. The format includes sections for analyzing contributing factors across environmental, equipment, and human elements, followed by recommendations for preventing future occurrences. This systematic approach ensures thorough incident documentation while promoting workplace safety improvements through careful analysis and preventive measures.

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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
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SMI INCIDENT WITNESS STATEMENT
This incident witness statement form template provides a structured format for documenting workplace incidents and accidents. The form includes essential sections for recording incident details, witness information, safety compliance checks, and detailed observations. It captures crucial information such as the date and time of the incident, location details, witness credentials, and specific observations about safety practices and personal protective equipment usage. The template also includes sections for describing the task being performed, how the incident occurred, and any resulting injuries. Complete with signature fields for both witness and supervisor verification, this form ensures thorough documentation of workplace incidents for safety compliance and record-keeping purposes.
by Mariah Oliveira, from the Community
Downloads: 50
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Accident, Incident or Near Miss investigation report

Description

About author

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INCIDENT/NEAR MISS INVESTIGATION REPORT and FIRST REPORT OF INJURY

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INCIDENT/NEAR MISS INVESTIGATION REPORT and FIRST REPORT OF INJURY

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