The job task that was being performed at the time of the incident?
Where and when it happened?
The equipment or material involved?
The individuals who were present?
Identify all factors that were involved in the incident, including (but not limited to):
Equipment malfunction or failure
Equipment in need of repair or maintenance
Facility factors, like poor visibility, damaged walking/working surfaces, or slip-and-trip hazards
Unauthorized personnel in a work area or performing a job task
Failure to take time to do the job properly
Failure to inspect equipment or missed inspection items
Lack of training
Note the following
Any warning signs observed before the incident
What the consequences might have been, including property damage, injury to workers, coworkers, or members of the public
Source: BLR (safety.blr.com)