SHEQ Incident / Accident Investigation

• Contract Number

• Job Number

• Location

• Date of Accident / Incident

  Date

• Prepared by

• Team Supervisor

• Additional personnel on site

• Brief description of work activity

• Client

• Principle Contractor

Initial Report

• Who

• What

• When

• Where

• Why

• How

• Other information

• Critical gaps

Full Investigation

• Time line of events

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Were the people involved competent and suitable?

  Yes

  No

  N/A

• Did the workplace layout influence the adverse event?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Was the safety equipment sufficient?

  Yes

  No

  N/A

• Did other conditions influence the adverse event?

  Yes

  No

  N/A

• Site Photos

  Yes

  No

  N/A

• Inductions

  Yes

  No

  N/A

• Training / Competency Records

  Yes

  No

  N/A

• Daily Risk Assessment

  Yes

  No

  N/A

• MSRA for works

  Yes

  No

  N/A

• Permit(s) to Work

  Yes

  No

  N/A

• LOLER & PUWER

  Yes

  No

  N/A

• Thorough Examination Records

  Yes

  No

  N/A

• Daily Plant / HGV / Vehicle Inspections

  Yes

  No

  N/A

• CAT & Genny calibration records

  Yes

  No

  N/A

• COSHH / MSDS

  Yes

  No

  N/A

• Lift Plan

  Yes

  No

  N/A

• Service Maps

  Yes

  No

  N/A

• Streetworks Permits / NIRAUC

  Yes

  No

  N/A

• Insurance Documents

  Yes

  No

  N/A

• Witness Statements

  Yes

  No

  N/A

• 3rd Party Witness Statements

  Yes

  No

  N/A

• First Aid Equipment used

  Yes

  No

  N/A

• RIDDOR reported

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 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>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Job factors?

  Yes

  No

  N/A

• Human factors?

  Yes

  No

  N/A

• Organisational factors?

  Yes

  No

  N/A

• Plant and equipment factors?

  Yes

  No

  N/A

• What risk control measures are needed/recommended?

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

  Yes

  No

  N/A

• Have similar adverse events happened before? Give details.

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

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