Title Page

  • Contract Number

  • Job Number

  • Location

  • Date of Accident / Incident

  • Prepared by

  • Team Supervisor

  • Additional personnel on site

  • Brief description of work activity

  • Client

  • Principle Contractor

Who / What / When / Where / Why / How?

Initial Report RTA

  • Who (Name, address & phone No of all involved)

  • What

  • When

  • Where

  • Why

  • How

  • Injuries sustained

  • Insurance details & confirm exchanged

  • Make, model, colour & registration of all vehicles involved

  • Damage to vehicles involved

  • Details of witnesses or police officers at scene

  • Weather conditions, unusual lighting, road quality, or suspected driver intoxitcation

Full Investigation

  • Time line of events

  • Was there anything unusual or different about the working conditions?

  • Were there adequate safe working procedures and were they followed?

  • What injuries or ill health effects, if any, were caused?

  • If there was an injury, how did it occur and what caused it?

  • Was the risk known? If so, why wasn’t it controlled? If not, why not?

  • Did the organisation and arrangement of the work influence the adverse event?

  • Was maintenance and cleaning sufficient? If not, explain why not.

  • Were the people involved competent and suitable?

  • Did the workplace layout influence the adverse event?

  • Did the nature or shape of the materials influence the adverse event?

  • Did difficulties using the plant and equipment influence the adverse event?

  • Was the safety equipment sufficient?

  • Did other conditions influence the adverse event?

Evidence provided (as required) of:

  • Site Photos

  • Inductions

  • Training / Competency Records

  • Daily Risk Assessment

  • MSRA for works

  • Permit(s) to Work

  • LOLER & PUWER

  • Thorough Examination Records

  • Daily Plant / HGV / Vehicle Inspections

  • CAT & Genny calibration records

  • COSHH / MSDS

  • Lift Plan

  • Service Maps

  • Streetworks Permits / NIRAUC

  • Insurance Documents

  • Witness Statements

  • 3rd Party Witness Statements

  • First Aid Equipment used

  • RIDDOR reported

  • Confirm incident communicated to SHEQ / DIRECTORS / CLIENT / HSENI

Analysing the Information

  • What was the immediate cause?

  • Underlying cause?

  • Root cause?

  • What happened and why?

  • Are human failings (errors and violations) identified as a contributory factor?<br>

  • Skill-based errors: a slip or lapse of memory?

  • Mistakes: errors of judgement (rule-based or knowledge-based)?

  • Violation (rule breaking) a contributory factor?<br>

  • Job factors?

  • Human factors?

  • Organisational factors?

  • Plant and equipment factors?

Risk Control Measures

  • What risk control measures are needed/recommended?

  • Do similar risks exist elsewhere? If so, what and where?

  • Have similar adverse events happened before? Give details.

  • Which risk control measures should be implemented in the short term?

  • Which risk control measures should be implemented in the long term?

  • Which risk assessments and safe working procedures need to be reviewed and updated?

  • Have the details of adverse event and the investigation findings been recorded and analysed?

  • Are there any trends or common causes which suggest the need for further investigation?

  • What did the adverse event cost? (Time / Effort / Financial costs / Cost to life)

Closing Summary

  • Add signature

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