Root Cause Analysis

• ROOT CAUSE ANALYSIS

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Determine Root Cause Do this investigation with an open mind, and assume the readers know nothing about the Accident Worker Accident Scene Focus on the facts, NOT opinions Provide sufficient details, be clear and concise

PEOPLE

• We're shortcuts avoided that could possibly be a safety issue

  Yes

  No

  N/A

• We're employees wearing proper PPE

  Yes

  No

  N/A

• Overextension / working on a ladder etc.

  Yes

  No

  N/A

PROCESS

• Was there adequate supervision

  Yes

  No

  N/A

• We're policies being enforced

  Yes

  No

  N/A

• Had the employee had adequate trading for the job

  Yes

  No

  N/A

• We're the expectations clear, and understood

  Yes

  No

  N/A

• Act or condition not covered please explain below

  Safe

  At Risk

  N/A

Equiptment

• We're all tools and equipment safe to use

  Yes

  No

  N/A

• Was the proper machine being used on the job

  Yes

  No

  N/A

Enviroment

• Was there proper lighting

  Yes

  No

  N/A

• We're the employees given a realistic deadline

  Yes

  No

  N/A

Attach supporting materials to your report. Photos / Diagrams

• Add media

  Media

• Add drawing

  Drawing

Background questions to know the answers to

• Had this risk been reported before

• Was problem corrected before, if so by who

• Have other events occurred at this site

• Has this employee been involved in other events

• Have other events occurred with this supervisor

• Explain in detail why this event happened

• What initiated the event

• List series of events that led to this event

• What was the last event before this accident

Incident Type

• Serious

• Major/Recordable

• First Aid Only

• Near Miss

This event was the result of

The above must be corrected by the following

CORRECTION MUST BE COMPLETED

• Before further use

• Within 3 days

• At earliest opportunity

Larry Richardson, Vice President Safety and Risk Control Watson electrical Construction, LLC 1500 Charleston Street, SE Wilson North Carolina 27893 252-237-7511 ext. 213 252-230-6871 cell