Incident Investigation Checklist


Incident Investigation Checklist

    Incident Identification:

    Short Description of Incident:

    Incident Location:

    Incident Date:

    Investigation Team Members:

    Supervisor of Area where incident occurred:

    OH&S Representative for Area:

    OH&S Specialist:

    Technical Specialist:

    Investigation Summary:

    Start Date:

    Statutory regulations for activity:

    EGW SOPs applicable:

    Documented work instruction for activity?

    Completion Date:


    LOCATION SKETCH (show movement direction, distances, relative locations, etc.)

    Add or drag pictures

    Step 1: FACT FINDING (to be completed at the scene of the incident)


    Who was involved in the incident?

    Who saw the incident?

    Who was working with the involved person?

    Who instructed and/or assigned the job to the person?

    Who else was involved?

    Who has information on events prior to the incident?

    Who assessed the risks involved in the job?

    Who was responsible for implementing risk controls?

    Who checked statutory knowledge of involved person? (if applicable)

    Who checked safety of equipment/plant prior to work commencing?


    Where did the incident occur?

    Where did the damage occur?

    Where was the supervisor at the time?

    Where were the witnesses at the time?

    Step 2: INCIDENT PROCESS DESCRIPTION (to be completed after the facts have been gathered)

    How did the incident occur? (list steps that led to incident)

    How did the injury occur? (list steps that led to injury)

    Step 3: IDENTIFY ESSENTIAL CONTRIBUTING FACTORS (refer to following table of potential contributing factors)

    List possible contributing factors.

    List all essential contributing factors.



    How could the incident have been avoided? (Subject to Job Analysis)

    How could the injury have been avoided?

    How could better job design be achieved?

    How could the supervisor have prevented the incident?

    How could better equipment design help?

    How can we detect systems failure before it occurs?

    How can we control failure (minimise consequences)?

    Step 5: IDENTIFY PREVENTATIVE / CORRECTIVE ACTIONS (refer to the Hierarchy of Control Table in Attachment 1 and the following list of preventative / corrective actions.)

    WHAT does the work process do?

    Why do we do this?

    What could we do instead?

    How else could we do it?




    Completion Date

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