For All Incidents
Has the injured person been contacted following the incident?
If no, what is the reason?
Did the injured person seek further medical treatment?
What is the current status of their injury?
Was assistance offered?
Was offer of assistance accepted?
Type of assistance provided
If assistance was declined please explain why
Was there any damage to property?
If yes, please detail.
Has any property damage been rectified?
Were Emergency Services required to deal with the incident?
Has an emergency services event number been recorded?
If yes, list
Has the contact information for all person's involved in the incident been added to the incident report?
Have witness statements been obtained from all relevant person's?
What exactly happened?
Where did it happen?
Who was involved?
How did it happen?
Why did it happen?
What immediate or emergency actions are taken to mitigate risk of recurrence of incident that lead to injury?
Who is responsible for implementing immediate actions?
List corrective actions to address root causes
Who is responsible for implementing corrective actions?
List preventative measures to address root causes
Who is responsible for implementing preventative measures?
Describe Actions to Ensure Proper Sharing / Communication
Is an ICCAM investigtion required?