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Incident Details

INCIDENT SUMMARY

Collect information and evidence of the incident and report your findings here.

Items

Item detail

Photo evidence
TIMELINE

List the activities and events leading up to the time of the incident, when the incident happened and what took place afterwards.

Activity
Date & Time

Activity

Analysis Overview

The basic cause of an incident is the mechanism of failure.

What happened?

The ICAM model analyses the contributing factors to determine why the incident happened.

Why did it happen?

Actual Consequence

Potential Consequence

ICAM Analysis

The contributing factors of this incident were analyzed using the Incident Cause Analysis Method (ICAM) process, an industrial safety initiative used to analyze serious incidents. ICAM is an analysis tool that sorts the findings of an investigation into a structural framework.

An ICAM analysis clarifies why the incident happened and identifies all the factors that contribute to the event. The contributing factors are classified into four categories of the ICAM model which are: Absent or Failed Defences; Individual or Team Actions; Task or Environmental Conditions; Organisational Factors.

Absent or Failed Defences

The situations, systems, conditions, equipment, measures or human factors which normally prevent this type of incident from happening.

Defence

Absent or Failed?

Organisational factor type

Details of defence

Individual or Team Actions

The errors or violations made by people directly involved in the event.

Actions

Individual or Team?

Organisational factor type

Details of Action

Task or Environment Conditions

The "situational characteristics" which existed immediately prior to the incident, including the work situation, physical or social environment, or a person's mental, physical or emotional state.

Conditions

Task or Environmental

Organisational factor type

Details of Condition

Organisational Factors

The latent system based factors present before the incident which may have contributed to the presence of specific adverse task or environmental conditions, individual or team actions, or absent or failed defences.

Factor
Organisational factor type

Details of Factor

Conclusion

Recommended Corrective Actions

What are we going to do about the incident?
Use the Hierarchy of Control recommendations for corrective actions that will target prevention of recurrence and reduction of risk.
The recommendations will address each identified absent or failed defence (risk controls) and Organisational factor (prevention and risk reduction strategies).

Enter recommended corrective actions here

CAR

CAR detail

Key Learnings

Enter Lessons Learned here

Lesson

Lesson

Sign off
ICAM Report Author

Incident Cause Analysis Method (ICAM) Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 1,755

This ICAM Investigation Report Checklist is used to assist in the investigation of incidents, accidents and near misses in the field and has been used extensively across the aviation, rail, road, mining and petroleum sectors. ICAM is the Incident Cause Analysis Method, an industrial safety initiative that provides the ability to identify what really went wrong and to make recommendations on necessary remedial actions to reduce risk and build error-tolerant defences against future incidents. Use this template as an example to build out a holistic safety solution appropriate for your organisation.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Incident Details

INCIDENT SUMMARY

Collect information and evidence of the incident and report your findings here.

Items

Item detail

Photo evidence
TIMELINE

List the activities and events leading up to the time of the incident, when the incident happened and what took place afterwards.

Activity
Date & Time

Activity

Analysis Overview

The basic cause of an incident is the mechanism of failure.

What happened?

The ICAM model analyses the contributing factors to determine why the incident happened.

Why did it happen?

Actual Consequence

Potential Consequence

ICAM Analysis

The contributing factors of this incident were analyzed using the Incident Cause Analysis Method (ICAM) process, an industrial safety initiative used to analyze serious incidents. ICAM is an analysis tool that sorts the findings of an investigation into a structural framework.

An ICAM analysis clarifies why the incident happened and identifies all the factors that contribute to the event. The contributing factors are classified into four categories of the ICAM model which are: Absent or Failed Defences; Individual or Team Actions; Task or Environmental Conditions; Organisational Factors.

Absent or Failed Defences

The situations, systems, conditions, equipment, measures or human factors which normally prevent this type of incident from happening.

Defence

Absent or Failed?

Organisational factor type

Details of defence

Individual or Team Actions

The errors or violations made by people directly involved in the event.

Actions

Individual or Team?

Organisational factor type

Details of Action

Task or Environment Conditions

The "situational characteristics" which existed immediately prior to the incident, including the work situation, physical or social environment, or a person's mental, physical or emotional state.

Conditions

Task or Environmental

Organisational factor type

Details of Condition

Organisational Factors

The latent system based factors present before the incident which may have contributed to the presence of specific adverse task or environmental conditions, individual or team actions, or absent or failed defences.

Factor
Organisational factor type

Details of Factor

Conclusion

Recommended Corrective Actions

What are we going to do about the incident?
Use the Hierarchy of Control recommendations for corrective actions that will target prevention of recurrence and reduction of risk.
The recommendations will address each identified absent or failed defence (risk controls) and Organisational factor (prevention and risk reduction strategies).

Enter recommended corrective actions here

CAR

CAR detail

Key Learnings

Enter Lessons Learned here

Lesson

Lesson

Sign off
ICAM Report Author