Title Page

  • INX Event Number

  • Event Type

  • Conducted on

  • Date of Event

  • Date of Investigation

  • Team Leader

  • Team Members

  • Location

PART 1: INCIDENT DETAILS

  • Brief Description of Event

PART 2: TIMELINE

  • Events Leading Up To The Incident

  • Events At The Time Of The Incident

  • Post Incident

PART 3: INVESTIGATION FINDINGS

    Absent or Failed Defences
  • Select an absent or failed defence

  • Description

  • Individual / Team Actions
  • Select a contributing individual or team action

  • Description

  • Task / Environmental Conditions (Workplace)
  • Select a contributing workplace factor that affected the task or environmental conditions

  • Description

  • Task / Environmental Conditions (Human)
  • Select a contributing human factor that affected the task or environmental conditions

  • Description

  • Organisational Factors
  • Select a contributing organisational factor

  • Description

PART 4: KEY LEARNINGS

  • Identify the root causes

PART 5: SUPPORTING DOCUMENTS (Attachments)

  • Photos

  • Add media

  • Written Statement

  • Training Records

  • Procedures

  • Sketches

  • Witness Statement

  • Inspection Records

  • Add media

  • Other:

  • Specify:

PART 6: CORRECTIVE ACTIONS

    Action
  • Action:

  • Action Responsibility:

  • Due Date:

PART 7: REVIEW AND APPROVAL

  • Department Manager

  • Investigation Leader

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