City of Ryde - Field Safety Officer Incident investigation

The reason for investigating an incident or near miss is to determine: the cause or causes of the incident; to identify any risks, hazards, systems or procedures that contributed to the incident; and to recommend corrective action to prevent similar incidents.
Incidents should be investigated by people knowledgeable about the type of work involved at the time of the incident. Relevant workers should also be involved in the investigation.
An incident /near miss investigation report should answer the WHO, WHERE, WHEN, WHAT, WHY and HOW questions with regard to an incident.

Short description of incident / near miss:

Name of injured person and job title (if relevant):

Injury sustained (if relevant):

Name of person who reported incident:

Name of witness or witnesses, their Job Title and contact details:

What Section is the investigation taking place in?

Building Services

Civil Construction

Passive Parks and Streetscapes

Public Domain

Sports Grounds, Regional Parks and Gardens

Stores & Porters Creek

What is the nature of this investigation?

Has a Pre-Start job checklist been completed

Has the Pre-Start job checklist been signed on to by all on site?

Is there a job specific site induction?

Has the job specific site induction been signed on to by all on site?

Immediate causes / Contributing Causes that may have been a factor to the accident/incident

What preventative action could have been taken? Why was this action not taken?

How much experience did the employee have in the task/s that was being performed when the accident / incident occurred? What training has been provided?

What is the likelihood of the accident / incident occurring again?

Briefly describe what happened including the sequence of events, investigate scene of incident or near miss; conditions present at time of incident; what was involved, what activity (if any) was taking place prior and at time of incident. What hazards was the worker exposed to? What hazards may have contributed to the incident occurring? (Attach photos if available)

INVESTIGATION RECOMMENDATIONS Outline recommended corrective action/s (i.e. solution/s) to prevent the recurrence of the incident eg. new equipment, re-engineer, re-design work area, re-design work practices, review training standards, etc

Insert any relevant photos of incident/accident site

Name of investigator