Initial Incident Investigation

• Incident Owner

• Reported By

• Incident Classifier

Initial Classification (Risk Assessment Matrix - RAM)

• People: Actual Severity Rating (0-5)

  Select No effect (0) Slight effect (1) Minor effect (2) Moderate effect (3) Major effect (4) Massive effect (5)

  • No effect (0)
  • Slight effect (1)
  • Minor effect (2)
  • Moderate effect (3)
  • Major effect (4)
  • Massive effect (5)

• Environment: Actual Severity Rating (0-5)

  Select No effect (0) Slight effect (1) Minor effect (2) Moderate effect (3) Major effect (4) Massive effect (5)

  • No effect (0)
  • Slight effect (1)
  • Minor effect (2)
  • Moderate effect (3)
  • Major effect (4)
  • Massive effect (5)

• Assets: Actual Severity Rating (0-5)

  Select No damage (0) Slight damage (1) Minor damage (2) Moderate damage (3) Major damage (4) Massive damage (5)

  • No damage (0)
  • Slight damage (1)
  • Minor damage (2)
  • Moderate damage (3)
  • Major damage (4)
  • Massive damage (5)

• Reputation: Actual Severity Rating (0-5)

  Select No impact (0) Slight impact (1) Minor impact (2) Moderate impact (3) Major impact (4) Massive impact (5)

  • No impact (0)
  • Slight impact (1)
  • Minor impact (2)
  • Moderate impact (3)
  • Major impact (4)
  • Massive impact (5)

Potential Risk Rating (e.g. 2B, 3E)

• People: Potential Risk Rating

  Never heard of in the industry (A)

  Heard of in the industry (B)

  Has happened in the Organisation or more than once per year in the industry (C)

  Has happened at the Location or more than once per year in the Organisation (D)

  Has happened more than once per year in the Organisation (E)

• Environment: Potential Risk Rating

  Never heard of in the industry (A)

  Heard of in the industry (B)

  Has happened in the Organisation or more than once per year in the industry (C)

  Has happened at the Location or more than once per year in the Organisation (D)

  Has happened more than once per year in the Organisation (E)

• Assets: Potential Risk Rating

  Never heard of in the industry (A)

  Heard of in the industry (B)

  Has happened in the Organisation or more than once per year in the industry (C)

  Has happened at the Location or more than once per year in the Organisation (D)

  Has happened more than once per year in the Organisation (E)

• Reputation: Potential Risk Rating

  Never heard of in the industry (A)

  Heard of in the industry (B)

  Has happened in the Organisation or more than once per year in the industry (C)

  Has happened at the Location or more than once per year in the Organisation (D)

  Has happened more than once per year in the Organisation (E)

Risk Outcome (Light Blue, Dark Blue, Yellow, or Red)

• People

  Select 0A 0B 0C 0D 0E 1A 1B 1C 1D 1E 2A 2B 2C 2D 2E 3A 3B 3C 3D 3E 4A 4B 4C 4D 4E 5A 5B 5C 5D 5E

  • 0A
  • 0B
  • 0C
  • 0D
  • 0E
  • 1A
  • 1B
  • 1C
  • 1D
  • 1E
  • 2A
  • 2B
  • 2C
  • 2D
  • 2E
  • 3A
  • 3B
  • 3C
  • 3D
  • 3E
  • 4A
  • 4B
  • 4C
  • 4D
  • 4E
  • 5A
  • 5B
  • 5C
  • 5D
  • 5E

• Environment

  Select 0A 0B 0C 0D 0E 1A 1B 1C 1D 1E 2A 2B 2C 2D 2E 3A 3B 3C 3D 3E 4A 4B 4C 4D 4E 5A 5B 5C 5D 5E

  • 0A
  • 0B
  • 0C
  • 0D
  • 0E
  • 1A
  • 1B
  • 1C
  • 1D
  • 1E
  • 2A
  • 2B
  • 2C
  • 2D
  • 2E
  • 3A
  • 3B
  • 3C
  • 3D
  • 3E
  • 4A
  • 4B
  • 4C
  • 4D
  • 4E
  • 5A
  • 5B
  • 5C
  • 5D
  • 5E

• Assets

  Select 0A 0B 0C 0D 0E 1A 1B 1C 1D 1E 2A 2B 2C 2D 2E 3A 3B 3C 3D 3E 4A 4B 4C 4D 4E 5A 5B 5C 5D 5E

  • 0A
  • 0B
  • 0C
  • 0D
  • 0E
  • 1A
  • 1B
  • 1C
  • 1D
  • 1E
  • 2A
  • 2B
  • 2C
  • 2D
  • 2E
  • 3A
  • 3B
  • 3C
  • 3D
  • 3E
  • 4A
  • 4B
  • 4C
  • 4D
  • 4E
  • 5A
  • 5B
  • 5C
  • 5D
  • 5E

• Reputation

  Select 0A 0B 0C 0D 0E 1A 1B 1C 1D 1E 2A 2B 2C 2D 2E 3A 3B 3C 3D 3E 4A 4B 4C 4D 4E 5A 5B 5C 5D 5E

  • 0A
  • 0B
  • 0C
  • 0D
  • 0E
  • 1A
  • 1B
  • 1C
  • 1D
  • 1E
  • 2A
  • 2B
  • 2C
  • 2D
  • 2E
  • 3A
  • 3B
  • 3C
  • 3D
  • 3E
  • 4A
  • 4B
  • 4C
  • 4D
  • 4E
  • 5A
  • 5B
  • 5C
  • 5D
  • 5E

Incident Subtype (select all subtypes that apply)

• People - Injury

• People - Illness

• Assets - API Process Safety Incident

• Assets - Fire/Explosion

• Assets - Property Loss/Damage

• Transportation by Road

• Environment (incl. LOC)

• Security

Incident Flags (select all types that apply)

• Fatality

• LTI

• RWC

• MTC

• Significant Incident

• High Potential Incident

• LSR Violation

Leading Cause

Root Causes

Actions

Attachments/Photos

• Add media

  Media

Full Tripod Investigation Required?

• Yes

  No