OHS Incident Investigation Report
ISO45001 Toolkit: Version 1 ©CertiKit [Type here]
[Type here]
[Type here]
OHS Incident Investigation Report
Implementation guidance The header page and this section, up to and including Disclaimer, must be removed from the final version of the document. For more details on replacing the logo, yellow highlighted text, and certain generic terms, see the Completion Instructions document.
Purpose of this document This form is used as part of the investigation of an occupational health and safety incident, to establish what happened and what can be done to avoid a recurrence.
Areas of the standard addressed This document addresses the following sections of the ISO45001 standard: •
8 Operation o 8.2 Emergency preparedness and response
General guidance This form is intended to be used where an incident has resulted in injury (often referred to as an accident) and in those cases where no injury resulted (often termed a near miss). Use this form in addition to regulatory reporting to reach a better understanding of the incident and most importantly what can be done to avoid such incidents in future, or at least make them less likely. Make sure this information is communicated to the hazard identification and risk assessment parts of the OH&S management system.
Review frequency This form should be reviewed at least annually.
Document fields This document may contain fields which need to be updated with your own information, including a field for Organization Name that is linked to the custom document property “Organization Name�. To update this field (and any others that may exist in this document): OHS-FORM-08-2 Version 1
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1. Update the custom document property “Organization Name” by clicking File > Info > Properties > Advanced Properties > Custom > Organization Name. 2. Press Ctrl A on the keyboard to select all text in the document (or use Select, Select All via the Editing header on the Home tab). 3. Press F9 on the keyboard to update all fields. 4. When prompted, choose the option to just update TOC page numbers. If you wish to permanently convert the fields in this document to text, for instance, so that they are no longer updateable, you will need to click into each occurrence of the field and press Ctrl Shift F9. If you would like to make all fields in the document visible, go to File > Options > Advanced > Show document content > Field shading and set this to “Always”. This can be useful to check you have updated all fields correctly. Further detail on the above procedure can be found in the toolkit Completion Instructions. This document also contains guidance on working with the toolkit documents with an Apple Mac, and in Google Docs/Sheets.
Copyright notice Except for any specifically identified third-party works included, this document has been authored by CertiKit, and is ©CertiKit except as stated below. CertiKit is a company registered in England and Wales with company number 6432088.
Licence terms This document is licensed on and subject to the standard licence terms of CertiKit, available on request, or by download from our website. All other rights are reserved. Unless you have purchased this product you only have an evaluation licence. If this product was purchased, a full licence is granted to the person identified as the licensee in the relevant purchase order. The standard licence terms include special terms relating to any third-party copyright included in this document.
Disclaimer Please Note: Your use of and reliance on this document template is at your sole risk. Document templates are intended to be used as a starting point only from which you will create your own document and to which you will apply all reasonable quality checks before use.
OHS-FORM-08-2 Version 1
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Therefore, please note that it is your responsibility to ensure that the content of any document you create that is based on our templates is correct and appropriate for your needs and complies with relevant laws in your country. You should take all reasonable and proper legal and other professional advice before using this document. CertiKit makes no claims, promises, or guarantees about the accuracy, completeness or adequacy of our document templates; assumes no duty of care to any person with respect its document templates or their contents; and expressly excludes and disclaims liability for any cost, expense, loss or damage suffered or incurred in reliance on our document templates, or in expectation of our document templates meeting your needs, including (without limitation) as a result of misstatements, errors and omissions in their contents.
OHS-FORM-08-2 Version 1
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Occupational Health and Safety Incident Investigation Report
Ref no: Name(s) of injured person(s): Date of incident: Location of incident: Length of absence from work:
Near miss
Accident
Undesirable occurrence:
☐
Ill health:
☐
Damage only:
☐
Minor injury:
☐
Serious injury:
☐
Major injury:
☐
Fatality:
☐
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Details of the incident WHAT WAS THE INJURED PERSON DOING AT THE TIME OF THE INCIDENT?
HOW DID THE INJURY/DAMAGE OCCUR, AND WHAT CAUSED IT?
DESCRIBE THE INJURIES/DAMAGE CAUSED AND ANY OUTSTANDING PROBLEMS
WHAT EMERGENCY MEASURES WERE TAKEN?
NAMES OF ANY WITNESSES, AND THEIR STATEMENT(S)
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NAME OF SUPERVISOR OF THE AREA WHERE THE INCIDENT OCCURRED
DETAIL ANY EQUIPMENT INVOLVED IN THE INCIDENT [Include name of equipment, model number and serial number. Had the injured party received training in the use of the equipment and/or the procedure being carried out?]
PROBLEMS WITH THE WORKING CONDITIONS [Detail any problems or anything different about the working conditions where the incident occurred]
WERE ADEQUATE SAFE WORKING PROCEDURES IN PLACE? [Were Standard Operating Procedures, COSHH [UK only] or risk assessments followed? Reference these if available]
WHAT PPE WAS BEING WORN BY THE PERSON INJURED/PRESENT AT THE TIME?
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WAS THE INJURED/AFFECTED PERSON COMPETENT? [Detail any training provided]
DID THE INJURED PERSON UNDERSTAND THE RISK ASSESSMENT/OTHER H&S INSTRUCTIONS? [Did the injured person, and other party(ies) involved in the incident, understand the risk assessment, and any health and safety instructions or methods of work?]
WAS THE HIERARCHY OF CONTROLS USED?
HAS A ROOT CAUSE ANALYSIS BEEN CARRIED OUT?
IS THE INCIDENT REPORTABLE BY LAW, AND HAS IT BEEN REPORTED? [Please note the details including the reference number]
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WAS CCTV BEING USED AT THE TIME, AND HAS FOOTAGE BEEN CHECKED/REQUESTED?
RECOMMENDATIONS
Initial investigation carried out by: Date:
Further investigation required?
YES
☐
NO
☐
Attach this report to a copy of incident form along with the regulatory reporting [UK – RIDDOR] document and any risk assessments and/or pictures taken of the area at the time.
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