Accident and Incident Investigation


Investigation Details

  • Who will be leading this investigation?

  • Who will assist in this investigation

  • Please enter the date of this investigation.

  • What kind of incident are you investigating?

  • Please add the accident/dangerous occurrence reference number this investigation relates too.

Incident Details

  • Name of injured person (if any)

  • Address
  • When did the incident occur?

  • What type of person was injured? (if any)

  • Which part of the body was injured? (if any)

  • Give details of any tasks being carried out at the time of the incident/injury?

  • Have all persons involved in the incident received information, instruction and training for the tasks relating to the incident?

  • Is there a Risk Assessment in place for this task

  • Enter title and last review date

  • When was the injured party last trained on the Risk Assessment?

  • Describe in detail what happened?

  • Describe in detail any injury sustained, if no injury, describe any damaged equipment, plant or machinery etc

  • Do you think any persons involved in the incident are negligent in any way, if yes, describe how.

  • Please add as many images as you can that relate to the incident.

  • List all witnesses of the incident

  • Witness Statement
  • Please interview all witnesses and ask for signatures

  • Name

  • Address
  • What did you see relating to this incident?

  • I confirm that the information I have provided in relation to this incident is accurate.

Medical Treatment

  • Was First Aid administered on-site

  • Describe what assistance was provided by the First Aider, list any medical equipment used (plasters, bandage, eyewash etc.)

  • Obtain signature of First Aider

  • Did you require any further treatment?

  • What was the outcome of this?

  • Please provide dates and times

How did the incident/injury occur?

  • Please list the main cause or causes of this incident or injury

  • Please list any contributing factor or factors relating to this incident or injury

  • Describe in detail your findings as to how the incident has occurred?

Corrective and Preventive Action

  • What corrective actions have been taken immediately?

  • Who carried out the corrective actions?

  • Describe what actions can be taken to prevent a recurrence of this incident (Improved training, PPE, improved housekeeping, improved maintenance etc)

  • Provide a monthly timescale for any improvements that will be made?

Incident Reporting

  • Did the injured person require time off work

  • How many days were they off work for?

  • Is this incident reportable under RIDDOR

  • Enter HSE report number and date reported.

  • Who completed the F2508 report?

  • Report now or check if reportable at the Riddor site online

Results of Investigation

  • Explain the results of your findings, take into account all factors and provide a balanced view, if there is a clear cause for the incident, be sure to list it.

  • If any equipment, plant, machinery have been damaged please list and describe the issues


  • I agree that all information provided by this investigation is accurate.

  • Signed by injured person

  • Signed by Lead Investigator

  • Signed by Assistant Investigator

  • Signed by Assistant Investigator

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.