Title Page
Follow up investigation report
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Project:
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Report number:
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Accident / Incident type.
- Accident Personal
- Accident Traffic
- H&S Hazard
- Fire Alarm
- Environmental Incident
- H&S Incident
- Near Miss
- Other
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Name of person completing form:
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Department:
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Signature:
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Date / Time
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Full Investigation due to:
- RIDDOR
- Hospital attendance
- Client request
- CCS request
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Further details of Accident / Incident/ Hazard.
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Actions taken:
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Findings of Investigation by Safety Engineer.
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RIDDOR reportable?
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If 'Yes' HSE Reference number:
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Reported by phone?
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Name and position of person reporting to HSE:
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Please provide copies of the following information where applicable.
Site Specific.
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Site diary information for the week of the Accident/incident copy provided or evidence seen.
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Time shift started (sign in day sheet), copy provided or evidence seen.
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Hours worked in previous 7 days (sign in day sheet), copy provided or evidence seen.
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Photographs of area, any plant/equipment, injuries and any other relevant issues, copy provided or evidence seen.
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Photographs:
General Information
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Were the persons involved authorised to be in the accident location? copy provided or evidence seen of Work instruction sheet.
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Add media
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Was a written risk assessment completed for the work activity being carried out, copy provided or evidence seen.
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Add media
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Were the persons involved complying with safe working procedures (provide a copy of operating instructions/safe system of work/ method statement, copy provided or evidence seen.
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Add media
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Was a manual handling assessment completed for the work activity being carried out, copy provided or evidence seen.
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Add media
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Was a COSHH assessment completed for the work activity being carried out, copy provided or evidence seen.
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Add media
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Were COSHH data sheets available , copy provided or evidence seen.
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Add media
Training
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Have the persons involved had an Health and Safety induction? copy provided or evidence seen.
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Add media
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Are the persons involved up to date on recent informal H&S information and toolbox talks, copy provided or evidence seen.
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Add media
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Have the persons involved received any other specialist training? copy provided or evidence seen.
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Add media
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Is the method statement correct and in date and briefed? copy provided or evidence seen.
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Add media
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Has a risk assessment briefing been given? copy provided or evidence seen.
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Add media
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Has a manual handling assessment been given? copy provided or evidence seen.
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Add media
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Were COSHH assessments given? , copy provided or evidence seen.
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Add media
Equipment
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Was any plant/equipment/vehicles involved in the accident ? copy provided or evidence seen.
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Add media
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Was a certificate or MOT required for the equipment? , copy provided or evidence seen.
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Add media
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When was the equipment last used? copy provided or evidence seen.
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Add media
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When was the equipment last inspected/ certified ? copy provided or evidence seen.
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Add media
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Who supplied the equipment ? copy provided or evidence seen.
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Add media
CDM Regulations
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Was the work subject to CDM regs (F10)? copy provided or evidence seen.
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Add media
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Is there a Health and Safety plan for the project? copy provided or evidence seen.
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Add media
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Is contractor competency information attached (where applicable)? copy provided or evidence seen.
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Add media
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Employers risk assessments/method statements (where applicable),copy provided or evidence seen.
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Add media
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Principal contractor details? copy provided or evidence seen.
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Add media
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Principal contractors representative? copy provided or evidence seen.
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Add media
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Details of person supervising the works? , copy provided or evidence seen.
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Add media
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Copied to:
- HSE dept (all incidents)
- Project/Site manager
- Personnel dept
- Other
