Investigation

INTRODUCTION

  • DATE & TIME OF INCIDENT

  • LOCATION OF INCIDENT
  • INTRODUCTION

BACKGROUND

  • BACKGROUND

SEQUENCE OF EVENTS

  • SEQUENCE OF EVENTS

INDICATION OF INJURIES

  • WAS THERE ANY INJURIES?

  • SELECT AREA OF INJURY?

  • DETAILS OF INJURY?

  • PHOTOGRAPHS OF INJURY

INDICATION OF DAMAGE TO PROPERTY

  • WAS THERE ANY DAMAGE TO PROPERTY?

  • RECORD DETAILS AND EXTENT OF DAMAGE

  • PHOTOGRAPHS OF DAMAGE

WITNESSES

  • WAS THERE ANY WITNESSES?

  • RECORD DETAILS OF WITNESSES

OBSERVATIONS (include any contributing factors)

  • OBSERVATIONS

  • Other Provide Details?

CONCLUSIONS (include any root causes)

  • CONCLUSIONS?

RECOMMENDATIONS (include any corrective, preventive actions)

  • RECOMMENDATIONS?

FURTHER ACTIONS

  • FURTHER ACTIONS

PHOTOGRAPHS

  • PHOTOGRAPHS

REPORT COMPLETED BY

  • INVESTIGATION COMPLETED BY:

  • DATE OF INVESTIGATION REPORT

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.