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Incident Investigation Form
"I need an Incident Investigation Form to document a machinery malfunction that occurred in our manufacturing facility on January 15, 2025, which resulted in minor injuries to two employees and requires RIDDOR reporting."
1. Incident Details: Date, time, location, type of incident
2. Persons Involved: Details of injured parties, witnesses, investigators
3. Incident Description: Detailed account of what happened
4. Initial Response: Immediate actions taken following incident
5. Evidence Collected: List of physical evidence, photographs, statements
6. Root Cause Analysis: Investigation findings and cause determination
7. Corrective Actions: Measures to prevent recurrence
1. RIDDOR Reporting: Additional section required when incident meets RIDDOR reporting criteria
2. Environmental Impact: Assessment of environmental consequences when incident involves environmental factors
3. Cost Analysis: Financial impact assessment when significant property damage or business interruption occurs
1. Witness Statements: Detailed accounts from witnesses
2. Photographic Evidence: Photos of incident scene and relevant items
3. Risk Assessments: Relevant pre-incident risk assessments
4. Equipment Records: Maintenance records, certificates, inspections
5. Training Records: Relevant training documentation for involved parties
Authors
Dangerous Occurrence
Near Miss
Incident
Injured Party
Investigator
Root Cause
Immediate Cause
Contributing Factors
Corrective Action
Preventive Action
RIDDOR
Competent Person
Witness
Material Evidence
Risk Assessment
Safe System of Work
Personal Protective Equipment (PPE)
Workplace
Working Hours
Control Measures
Hazard
Risk
Safety Critical Equipment
Serious Injury
Work-Related Illness
Lost Time Incident
First Aid Treatment
Emergency Services
Investigation Team
Personal Information
Location and Time
Environmental Conditions
Equipment Involved
Injury Description
Witness Information
Evidence Collection
Root Cause Analysis
Risk Assessment
Immediate Actions
Corrective Measures
Preventive Actions
Reporting Requirements
Confidentiality
Data Protection
Documentation
Follow-up Actions
Training Requirements
Health and Safety
Emergency Response
Investigation Process
Legal Compliance
Insurance Notification
Record Keeping
Management Review
Sign-off Requirements
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