This form is to be completed by the supervisor of an employee that has experienced an incident resulting in a serious injury or illness. It shall be completed in a timely manner following an incident, and can also be used to investigate a "near miss"

Complete an Incident Investigation Report after you have gathered all possible evidence. See the text for information on how to complete this form. ©2009 National Safety Council.

2019年9月19日 · Included on this page, you will find an employee incident/accident report form, a supervisor's incident investigation report template, a statement of witness to accident template, an employee's return to work plan, and many more helpful workplace accident report forms.

Download or preview 2 pages of PDF version of Incident investigation form (DOC: 63.0 KB | PDF: 170.6 KB ) for free.

OSHA created this Guide to help employers conduct workplace incident investigations using a four‐step systems approach. This process is supported by an Incident Investigation Form, found in Appendix A, which employers can use to be sure all details of …

2024年9月30日 · An incident report is used to formally document an event that involves an accident, injury, property damage, or other unusual activity. Commonly used in the workplace, an incident report can help employers reduce liability by addressing problematic employees or processes in an effort to prevent harmful incidents from recurring.

(Investigate scene of incident or conditions. Describe who was involved, when and where the incident happened, what happened, and how.) Why did it happen? (Root Cause Analysis) (What was the root cause of the incident, i.e., actually caused the illness, injury, or incident?) List immediate actions taken and results.

The Incident Investigation Report Form Template is an invaluable tool for businesses aiming to enhance their safety protocols and risk management strategies. By systematically documenting and analyzing each incident, organizations gain insights that are crucial for …

Our free incident report template is easy to use and provides a structured format for capturing essential information related to the incident. It covers key details such as the date and time of the incident, location, description, and involved individuals.

Supervisor’s Accident Investigation Form (Cont.) Prevention What should be done and by whom to prevent recurrence of this type of incident? (Include target dates.)