Safety Incident Investigation Report Form

$10.00

This is a complete version of a safety incident investigation loaded with checkbox information that will ease the investigation of an incident. This will also avoid missing information that can support the investigation.

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Contributor
John Phillip Mier
Document Type
Document
Language
N/A
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Full Description

The following are the categories of information loaded on this form:
1. Accident / Incident Severity and Classification
2. Concerned Personnel Details
3. Injury / Occupational Illness Details
4. Damages Details
5. Body Part Injured Details
6. Property Damages Details
7. Accident/Incident Details
8. Description of the Accident/Incident
9. Accident Type/Contact
10. Source of Injury/Property Damage
11. Root Cause – Underlying Causes
12. Indirect Personnel Causes
13. Indirect Environment Causes
14. Primary Unsafe Act
15. Primary Unsafe Condition
16. Root Cause AnalysisFive Why’s Analysis
17. Immediate Action Taken
18. Recommendation
19. Corrective Action Taken
20. Corrective Action Details

SKU: 20210707A Category:

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