| Source: XpertHR P&D |
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Date: 06/06/2004 |
Publisher: XpertHR |
Health and safety: Accident investigation form (form)
TOPICS:| health and safety | incidents
health and safety management
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This form is provided by RSK ENSR Health & Safety Ltd.
Form wording:
| Department/Project |
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| Investigator |
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| Report date |
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| Reference |
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| Investigator's telephone number |
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| Full address and location of accident |
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| Date of accident |
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| Time of accident |
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| Work activity involved |
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| Persons involved/affected |
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| Description of how accident occurred |
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| Use this space to sketch site if necessary |
Attach photographs where necessary |
| Immediate causes |
What unsafe acts or conditions caused the accident?
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| Causal agents |
What management, human, organisation or job factors caused the accident?
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| Recommendations to prevent recurrence |
Number recommendations
1. | |
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