Investigation Report

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name:

• Date of incident:

  Date

• Type of Incident?

  Select Personal injury Taken Ill at Work Vehicle Damage Property Damage RTA Environmental Near Miss Business Loss/Risk

  • Personal injury
  • Taken Ill at Work
  • Vehicle Damage
  • Property Damage
  • RTA
  • Environmental
  • Near Miss
  • Business Loss/Risk

Information gathering

• 1. Where did the incident happen?

• 2. Who was involved?

• 3. What were the consequences? (use additional information sheets if required)

• Likelihood of it happening again?

  Certain

  Likely

  Possible

  Unlikely

  Rare

• Potential WORST consequences of adverse event

  Minor

  Major

  Serious

  Fatal

• Is an investigation required? (if so continue completing report)

  Yes

  No

  N/A

• If the likelihood and potential worst consequence are low and haven't been flagged, an investigation is not required. End this report here and email to your line manager & health.safety@binngroup.co.uk.

  

Timeline

• Please give a brief outline of timelines eg 9am Noticed oil, 9.10am applied skill kit, 9.15am advised supervisor

• What activities were being carried out at the time?

• Were the persons involved competent & trained?

  Yes

  No

  N/A

• Was there RAMS or a SSOW for the task?

  Yes

  No

  N/A

• In relation to the working environment and/or equipment involved, was maintenance and cleaning up to date?

  Yes

  No

  N/A

Document Gathering

• Witness Statement

  Yes

  No

  N/A

• CCTV

  Yes

  No

  N/A

• RAMS

  Yes

  No

  N/A

• COSHH

  Yes

  No

  N/A

• Photos

  Yes

  No

  N/A

• Anything else relevant to the investigation

  Yes

  No

  N/A

Findings

• Please now provide a factual overview of the event. Add media (photos) and drawings where applicable

• undefined

Analysis

• Please now complete 5 Why analysis. Continue to answer the question why until there are no more answers

• Why?

• Why?

• Why?

• Why?

• Why?

Cause

• Immediate

• Underlying

• Root Cause

Culpability

• Please now complete the culpability flowchart to help with any further action required

Further Action

• What additional risk control measures are required to prevent recurrence?

• Do similar risks exist elsewhere in the company?

  Yes

  No

  N/A

• Recommendations & Actions