Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Accident Investigation

  • Are ALL employee injuries reviewed for corrective actions?

  • What percentage of injuries are reviewed for corrective actions?

  • Is an accident investigation form completed for each employee injury?

  • Does the accident investigation form identify root causes that led to the employee injury?

  • Does the accident investigation document have a section for corrective actions?

  • Is there a safety committee in place to review accidents?

  • Would you like assistance starting a certified safety committee?

  • Does the safety committee discuss and document corrective actions?

Return-to-Work

  • Can modified duty be accommodated within the injured workers department?

  • If accommodation can't be made in the injured employees regular department, can you transition an injured worker to a different department?

  • Has a list of modified duty tasks been developed?

  • Has a policy statement been developed that communicates to employees your Return-to-Work commitment after a workplace injury has occurred?

  • Has the policy been reviewed and signed by all current employees and new hires?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.