Accident investigation check list

• Accident Investigation Number

• Prepared by

• Date the Investigation was completed

  Date

• Name of Injured person

• Has prompt emergency action been taken e.g. first aid?

  Yes

  No

  N/A

• Has the area been made safe?

  Yes

  No

  N/A

• Visit to Accident Site Has the scene of the accident been preserved?

  Yes

  No

  N/A

• Have you taken photographs of the accident site? (site as found, from several angles)

  Yes

  No

  N/A

• Have you recorded the precise location of the accident? inc room number & building

  Yes

  No

  N/A

• Would drawings or plans help to explain the accident?

  Yes

  No

  N/A

• Have you recorded details of equipment/ vehicles involved? Serial no/ make/ model?

  Yes

  No

  N/A

• Is the accident site covered by CCTV?

  Yes

  No

  N/A

• Have you considered restaging site conditions prior to accident?

  Yes

  No

  N/A

• Do you have a clear picture of how the incident happened?

  Yes

  No

  N/A

Documents that need to be collected

• Accident report form?

  Yes

  No

  N/A

• Accident investigation form?

  Yes

  No

  N/A

• Photos of injury?

  Yes

  No

  N/A

• E-mail(s) relating to the incident ?

  Yes

  No

  N/A

• Safety Policy?

  Yes

  No

  N/A

• Risk Assessments?

  Yes

  No

  N/A

• Control of Substances Hazardous to Health (COSHH) Assessments (chemicals/ biological)?

  Yes

  No

  N/A

• Manual Handling Assessments?

  Yes

  No

  N/A

• Monitoring records e.g. health surveillance, dust or noise assessments?

  Yes

  No

  N/A

• Training documents?

  Yes

  No

  N/A

• Records of maintenance or testing (internal or external)?

  Yes

  No

  N/A

• Previous incident reports for similar/ identical incidents?

  Yes

  No

  N/A

Physical Evidence

• Equipment- whole or damaged parts

  Yes

  No

  N/A

• Clothing including personal protective equipment

  Yes

  No

  N/A

• Articles or substances

  Yes

  No

  N/A

• Other items (specify) Click here to enter text.

  Yes

  No

  N/A