Information
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Conducted on
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Prepared by
Post Accident Checklist
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First aid has been rendered to affected employee(s).
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Area is secured and environmental conditions leading to accident have been eliminated.
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Workers in the immediate area have been evacuated as needed to remove them from potential hazards.
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Site owner and stakeholders have been informed.
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Area is barricaded or secured to prevent entry by non-qualified investigators.
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WES Safety Manager has been notified.
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WES Senior Managers (VP, Regional, Supervisors) have been informed. (Site Lead may direct Safety Manager to complete management notification if needed)
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Has OSHA or other regulatory agencies been informed?
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Has OSHA or other regulatory agencies been informed?
Accident Investigation Information
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Location of incident / accident.
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Date and Time accident / incident occurred.
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List all personnel involved with incident / accident.
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Involved personnel have been directed (as possible) to provide a written statement of events leading up to accident, account of accident, and post-accident observances.
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List all personnel who witnessed incident / accident.
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All witnesses have been directed to provide a written statement of events leading up to accident, account of accident, and post-accident observances.
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Photos / Videos of Incident / Accident area taken. Media should include all pertinent areas of failed equipment, processes or contributing factors.
Post Accident
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Based on facts obtained through investigation, what is the investigation team's assessment of the causal factors?
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Have the causal factors been eliminated through training, engineering, LOTO or other means?
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Has training been completed with all onsite personnel to prevent similar incidents?
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Do client stakeholders accept the results of the accident and steps taken to prevent future incidents?
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Have WES senior management personnel (VP, Regional) accepted the results of the accident and steps taken to prevent future incidents?
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Have client stakeholders given permission to re-commence work tasks?
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Have WES senior management personnel (VP, Regional) given permission to re-commence work tasks?
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If OSHA or other regulatory agencies are involved, have they given permission to proceed with work?
Document Processing
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All witness statements printed out and attached to this investigation checklist.
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Incident, Accident or Near Miss has been properly recorded as required by local, state or federal agencies.
9.0 Sign Off
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Qualified operator performing inspection:
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Date and time of inspection:
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Signature of qualified operator performing inspection:
