Burnley College Accident / Near Miss / Ill Health Investigation

• Audit Title

• Department / Division

• Conducted on

  Date

• Prepared by

Type of Event

• Type of Event

  Accident

  Ill Health

  Near - Miss

  Undesired Circumstance

Actual / Potential for harm

• Actual / Potential for halm

  Fatal or Major

  Serious

  Minor

  Damage only

Reporting

• RIDDOR Reportable

  Yes

  No

  N/A

• Date RIDDOR report submitted:

  Date

• Entry in Accident book

  Yes

  No

  N/A

• Date of accident book entry

  Date

Further Investigation?

• Further investigation required?

  Yes

  No

  N/A

• Obtain witness statements

• Where and when did the adverse event happen?

• 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?

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

• 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? If so, why was it not controlled? If not why not?

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

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

• Where the people involved competent and suitable?

• Did the workplace layout influence the adverse event?

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

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

• Was the safety equipment sufficient?

• Did other conditions influence the adverse event?

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

• Have similar adverse events happened before? Give details.

• What were the immediate, underlying and root causes?

• Review the relevant method statement and risk assessment

• What risk control measures are needed / recommended? What timescale? Who is responsible for closing the control measures out?

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