Incident Investigation Form Template for South Africa

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Key Requirements PROMPT example:

Incident Investigation Form

"I need an Incident Investigation Form for our manufacturing company with operations across three provinces in South Africa, which must include specific sections for machinery-related incidents and allow for digital signature collection from our safety officers."

Document background

The Incident Investigation Form is a critical document used in South African workplaces to ensure thorough and compliant investigation of workplace incidents, accidents, and near-misses. This document is mandated by the Occupational Health and Safety Act (OHSA) No. 85 of 1993 and must be completed whenever a reportable incident occurs in the workplace. The form captures essential information about the incident, including circumstances, involved parties, witness accounts, root cause analysis, and corrective actions. It serves multiple purposes: ensuring legal compliance, preventing future incidents, supporting worker compensation claims, and maintaining safety records. The structured format helps organizations maintain consistent investigation practices while meeting the requirements of South African health and safety regulations.

Suggested Sections

1. Incident Reference Information: Basic identifying information including incident number, date/time of incident, date/time reported, and location

2. Type of Incident: Classification of incident (injury, near-miss, property damage, environmental, etc.) and severity rating

3. Affected Persons: Details of all persons involved, injured or affected by the incident, including employees, contractors, or members of the public

4. Incident Description: Detailed narrative of what happened, including sequence of events and immediate actions taken

5. Environmental Conditions: Weather, lighting, workplace conditions, and other environmental factors at time of incident

6. Equipment Involved: Details of any machinery, tools, or equipment involved in the incident

7. Witness Information: Names and contact details of witnesses, with reference to their statements

8. Root Cause Analysis: Investigation findings identifying direct and underlying causes of the incident

9. Immediate and Underlying Causes: Analysis of factors that contributed to the incident

10. Corrective Actions: Specific actions required to prevent recurrence, including responsible persons and timelines

11. Investigation Team: Names and roles of persons conducting the investigation

12. Sign-off Section: Signatures of investigation team, safety representative, and management

Optional Sections

1. Medical Report Section: Required when incident involves injury - details of medical treatment, first aid provided, and medical professional's assessment

2. Environmental Impact Assessment: Required for incidents involving environmental damage or potential environmental risks

3. Cost Impact Analysis: Optional section for calculating direct and indirect costs of the incident

4. Legal Compliance Review: Required when incident involves potential regulatory breaches

5. Union Representative Input: Required when incident involves unionized employees or workplace representation is necessary

6. Risk Assessment Review: Required when incident reveals new or previously unidentified risks

7. Training Record Review: Required when incident may be related to training inadequacies

Suggested Schedules

1. Appendix A - Witness Statements: Detailed statements from all witnesses, signed and dated

2. Appendix B - Photographic Evidence: Photos of incident scene, damage, or relevant equipment with descriptions

3. Appendix C - Sketches and Diagrams: Drawings showing incident scene layout and relevant details

4. Appendix D - Supporting Documentation: Relevant procedures, risk assessments, maintenance records, training records

5. Appendix E - Medical Reports: Copies of medical assessments, treatment records (if applicable)

6. Appendix F - Equipment Reports: Technical reports, maintenance records, or inspection certificates for involved equipment

7. Appendix G - Incident Timeline: Detailed chronological sequence of events before, during, and after the incident

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Manufacturing

Mining

Construction

Transportation

Healthcare

Agriculture

Retail

Warehousing and Logistics

Education

Hospitality

Chemical Industry

Energy and Utilities

Maritime

Aviation

Public Sector

Food Processing

Pharmaceutical

Relevant Teams

Health and Safety

Operations

Human Resources

Quality Assurance

Risk Management

Compliance

Security

Facilities Management

Production

Maintenance

Occupational Health

Training and Development

Legal

Environmental Management

Relevant Roles

Health and Safety Manager

Risk Manager

Operations Manager

Site Supervisor

Production Manager

Human Resources Director

Facility Manager

Quality Assurance Manager

Security Manager

Department Supervisor

Plant Manager

Environmental Health and Safety Coordinator

Compliance Officer

Safety Inspector

Line Supervisor

Occupational Health Nurse

Training Coordinator

Maintenance Manager

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Let's create your Incident Investigation Form

Authors

Alex Denne

Find the exact document you need

Security Guard Report Form

Patient Safety Incident Reporting Form

Incident Notification Form

Health And Safety Incident Report Form

Hazard Incident Report Form

Work Place Injury Report Form

Critical Incident Report Form

Security Incident Report Form

Incident Response Form

Incident Investigation Form

Download our whitepaper on the future of AI in Legal

Genie’s Security Promise

Your documents are private:

Your documents are protected:

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Innovation in privacy:

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