1 / 5

Accident/Incident/Injury Investigation

Accident/Incident/Injury Investigation. Investigation Performed By: (your name here) Regarding: (date of incident - Subdivision – Type of Accident/Incident/Injury) report prepared: (date). Incident Fact Sheet. Project: XXXXXXX Division: XXXXXXXX Subdivision: XXXXXXXXX

julioreed
Download Presentation

Accident/Incident/Injury Investigation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Accident/Incident/Injury Investigation Investigation Performed By: (your name here) Regarding: (date of incident - Subdivision – Type of Accident/Incident/Injury) report prepared:(date)

  2. Incident Fact Sheet Project: XXXXXXX Division: XXXXXXXX Subdivision:XXXXXXXXX Physical Location:(near city, state) Actual location of Incident:(example: CP Midland, MP 234.9, County Road 25) Date & Time: (00:00 hrs, XX/XX/XX) Director:XXXXXXXX General: XXXXXXX Supervisor:XXXXXXXX Foreman: XXXXXXXX Vehicle info: RC Unit #: XXXX Other Driver’s Name: XXXXXXX Other Driver’s Insurance info: XXXXXX Other Driver's Phone number: XXX-XXX-XXXX Make, Model and Tag number of any involved Vehicles: XXXXXXXXX Weather/Visibility:(conditions at time of incident) Type of Road: (Gravel, two lane highway, four lane interstate) * Include any rules violations/ Ops Test Failures where relevant to the incident.

  3. Incident Fact Sheet Task Being Performed:(example: digging trench, installing house, etc.) Employees Present at Time of Incident:(List all employees present along with position. Ex: John Smith – Foreman) Rule Violation: (List RC rule violation if any apply) Description of Injury:(Doctor’s diagnosis as reported if any) Description of Incident:(What happened) * Include any rules violations/ Ops Test Failures where relevant to the incident.

  4. Photos for Illustration of Incident

  5. 3P(Process, People, Product) Analysis Process: People: Product: CORRECTIVE ACTION CAUSAL FACTORS Process: People: Product: Product – Is there any evidence of defective equipment, appliances, or other physical contributing factor or environmental condition? Process – Would adherence to applicable rules, processes, and operating practices in place have prevented the incident? People – rule violations, failures, human factor behavioral exceptions Corrective Actions – include timelines and responsible persons

More Related