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Incident Investigation Form
"Need an Incident Investigation Form to document a chemical spill that occurred in our Singapore manufacturing facility's R&D lab on March 15, 2025, involving two researchers and resulting in minor injuries requiring first aid treatment."
1. Incident Details: Date, time, location, and type of incident
2. Affected Parties: Information about injured/affected individuals including names, roles, and contact details
3. Incident Description: Detailed account of what happened including sequence of events
4. Immediate Actions Taken: Emergency response and immediate control measures implemented
5. Investigation Findings: Root cause analysis and contributing factors identified during investigation
6. Corrective Actions: Measures to prevent recurrence including implementation timeline
1. Witness Statements: Detailed statements from witnesses who observed the incident
2. Environmental Conditions: Weather, lighting, workplace conditions at time of incident
3. Equipment Details: Information about machinery/equipment involved including maintenance history
4. Medical Reports: Details of injuries sustained and medical treatment provided
1. Photographs: Visual documentation of the incident scene and relevant evidence
2. Diagrams/Sketches: Visual representations of incident sequence and scene layout
3. Supporting Documents: Relevant documentation including maintenance records, training certificates, and procedures
4. Risk Assessment: Pre-incident risk assessment documentation and analysis
5. Investigation Team Details: Names, roles, and qualifications of investigation team members
Authors
Near Miss
Accident
Dangerous Occurrence
Affected Party
Investigating Officer
Root Cause
Contributing Factor
Corrective Action
Preventive Action
Workplace
Risk Assessment
Control Measures
Personal Protective Equipment (PPE)
Hazard
Safe Work Procedure
Immediate Cause
Underlying Cause
Safety Equipment
Work-Related Injury
Lost Time Injury
First Aid Case
Medical Treatment Case
Reportable Incident
Safety Breach
Competent Person
Direct Supervisor
Witness Statement
Investigation Team
Safety Management System
Incident Classification
Injury Description
Property Damage
Environmental Impact
Immediate Response
Root Cause Analysis
Witness Information
Evidence Collection
Investigation Methodology
Timeline of Events
Risk Assessment
Regulatory Reporting
Corrective Actions
Preventive Measures
Follow-up Procedures
Documentation Requirements
Confidentiality
Data Protection
Record Keeping
Authority and Responsibilities
Sign-off Requirements
Review Process
Distribution of Findings
Training Requirements
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