Title Page
- Injured Person Name
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Investigation Opened on
-
Lead Investigator by
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Incident Location
-
Incident Date
-
Days off work:
DOCUMENTATION & EVIDENCE
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Incident Report Form
-
RIDDOR Notification
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Injured Person Statement
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Witness Statement/s
-
Incident Photos / CCTV Footage
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RAMS Prior to incident
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RAMS Following incident
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Training History
-
Induction Records and Communication History
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Inspection Records
-
Service Records
-
Permit Information
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E-mail Correspondence
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Return to work information
-
Solicitors/Insurance Information
-
Other relevant Information
Investigation Report
-
Investigation Team
-
Incident Details and Summary
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Witnesses/s
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Details of Injuries / Damage
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Incident Type:
- Safety
- Health
- Environment
- Property
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Root Cause and Contributory Factors
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Equipment / Material
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Culture
-
Policy & Process
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Environment
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Other
-
Legislation applicable to incident
ACTIONS
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Any actions required following investigation:
INVESTIGATION TEAM SIGN-OFF
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Investigation carried out by:
-
Investigation carried out by:
-
Investigation carried out by:
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Investigation carried out by:
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Investigation carried out by:
