Accident & Incident Investigation Report

• Conducted on

  Date

• Investigation Prepared by

• CFL Reference Number

• Build Partner

  Select Dig & Fix GNS CMCCE DBS Spliceteq Skilled Contracts RS Preparation CFIP (Direct Labour) Softel KNTC Infinity Fibre

  • Dig & Fix
  • GNS
  • CMCCE
  • DBS
  • Spliceteq
  • Skilled Contracts
  • RS Preparation
  • CFIP (Direct Labour)
  • Softel
  • KNTC
  • Infinity Fibre

• Accident/ Incident/ Near Miss Report

  Media

• Accident / Incident Reported by

• Date and Time of Accident / Incident

  Date

• Brief details (What, where, when, who and emergency measures taken)

• Type of event

  Accident

  Incident / Near Miss

  Occupational Ill Health

• Actual/potential for harm

  Fatal or Major

  Serious

  Minor

  Property Damage

• Is the occurrence RIDDOR reportable?

  Yes

  No

• Date/time reported

  Date

• Initial assessment carried out by

• Initial assessment Date / Time

  Date

• Where and when did the adverse event happen?
  Address

• Who was injured/suffered ill health or was otherwise involved with the adverse event?

• How did the adverse event happen? (Note any equipment involved.)

• What activities were being carried out at the time?

• Was there anything unusual or different about the working conditions?

  Yes

  No

• Were there adequate safe working procedures and were they followed?

  Yes

  No

  N/A

• What injuries or ill health effects, if any, were caused?

• If there was an injury, how did it occur and what caused it?

• Was the risk known?

  Yes

  No

  N/A

• Why wasn’t the risk controlled?

• Did the organisation and arrangement of the work influence the adverse event?

  Yes

  No

• Was maintenance and site condition sufficient? If not, explain why not.

  Yes

  No

  N/A

• Were the people involved competent and suitable?

  Yes

  No

  N/A

• Did the workplace layout influence the adverse event?

  Yes

  No

• Did the nature or shape of the materials influence the adverse event?

  Yes

  No

• Did difficulties using the plant and equipment influence the adverse event?

  Yes

  No

• Was the safety equipment sufficient?

  Yes

  No

  N/A

• Did other conditions influence the adverse event?

  Yes

  No

• H&S Specialist comments and recommendations

Analysis and further action

• What were the immediate, underlying and root causes?

• What risk control measures are needed/recommended?

• Do similar risks exist elsewhere? If so, what and where?

  Yes

  No

• Have similar adverse events happened before? Give details.

• Which risk control measures should be implemented in the long and short term?

• Completion date

  Date

• Person responsible

• Do risk assessments and safe working procedures need to be reviewed and updated?

  Yes

  No

• Name of risk assessment safe working procedure

• Completion date

  Date

• Person responsible

• Have details of the event and the investigation findings been analysed? Is further investigation required?

  Yes

  No

• CFIP Impact / Cost

  Select Statutory Commercial Reputation None

  • Statutory
  • Commercial
  • Reputation
  • None