Information

  • Incident description

  • Bechtel #

  • Vessel / Location

  • Conducted on

  • Prepared by

  • Document No.

1. INVESTIGATIVE TEAM MEMBERS

  • Names of investigative team

2. IMPORTANT

  • Have Bechtel been notified?

  • Time and Date

  • Person notified

  • INFORM BECHTEL

  • Has a drug and alcohol test been arranged?

  • Time and date

  • Person notified

  • D&A TEST REQUIRED WITHIN 2Hrs

3. INCIDENT DETAILS

  • Date and time of incident

  • Vessel or Location of incident

  • Incident

  • Incident type

  • Has the Medic been informed?

  • Inform the Medic

  • Other - List

  • Person(s) involved

  • Plant / Equipment involved

  • Injuries / Damage sustained

  • Damages cost estimate

  • Sequence of events

4. EVIDENCE

  • Photographs

  • Enter drawings?

  • Drawing
  • Drawing

  • Enter statements?

  • Statement
  • Statement

  • Signature

5. 5 WHY

  • 1. Why did the incident happen?

  • Supporting data

  • 2. Why did 1 happen?

  • Supporting data

  • 3. Why did 2 happen

  • Supporting data

  • 4. Why did 3 happen?

  • Supporting data

  • 5. (Optional) Why did 4 happen?

  • Supporting data

6. ROOT CAUSE (What was the answer to the last question?)

  • Enter root cause?

  • Root cause
  • Root Cause

7. RECOMMENDATIONS

  • Enter recommendation?

  • Recommendation
  • Recommendation

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