
Employer Incident Investigation Report (EIIR)Please refer to the companion quick guide for assistance completing the investigation and this form. 1. Employers information Employers name (legal name.
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How to fill out the Incident Investigation Report Template online
Filling out the Incident Investigation Report Template is an essential process to ensure thorough documentation of workplace incidents. This guide provides clear, step-by-step instructions to assist you in accurately completing the form online.
Follow the steps to successfully complete the Incident Investigation Report Template.
- Click ‘Get Form’ button to obtain the form and open it in your editor.
- Begin with section 1, where you will input the employer's information. This includes the employer's legal name and trade name, WorkSafeBC account number, operating location number, and the address details including city, province, and postal code. Ensure to include the name, phone number, and email address of the employer's representative.
- In section 2, fill in the details of the injured persons. Provide the last name, first name, and job title of the individuals involved in the incident.
- Proceed to section 3 to document the place, date, and time of the incident. Specify the location where the incident occurred, include the city and province, as well as the date and time in the required format.
- In section 4, select the type of occurrence by checking all boxes that apply, for example, if it involves a serious injury, dangerous incident, or other circumstances specified in the form.
- Complete section 5 by indicating the report type. Select any applicable options such as Preliminary Investigation Report, Full Investigation Report, and provide the corresponding report dates.
- Section 6 requires you to list any witnesses. Include their last names, first names, and job titles.
- Follow up with section 7, which is for other persons whose presence might aid the investigation. Fill in the required details just as you did in section 6.
- In section 8, describe the sequence of events that led to the incident. Provide detailed information to depict the circumstances and activities that occurred prior.
- In section 9, outline any unsafe conditions or acts that significantly contributed to the incident. Clearly explain factors that may have led to the hazard.
- If applicable, proceed to section 10 to describe the nature of the serious injury, if any, by selecting the appropriate categories.
- In section 11, provide a brief description of the incident, including a summary of events and unsafe factors.
- Complete section 12 by identifying any corrective actions that were taken. Include who is responsible for these actions and the expected completion dates.
- If there are any blank areas in the report, section 13 will require you to explain the reasons for this absence of information.
- Sections 14 through 19 require you to document participants in both the preliminary and full investigations, as well as any other relevant workplace parties.
- Once all sections are completed, review the form for accuracy and detail. Finally, save your changes, and choose whether to download, print or share the completed form as needed.
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Get answers to your most pressing questions about US Legal Forms API.
What are the 4 stages of incident investigation?
Employers are responsible for completing reports to represent the four stages of an investigation: preliminary investigation, interim corrective actions, full investigation, and full corrective actions.
What are the 4 types of incident reports?
The 4 main incident reports that should be on your list are: Near Miss Reports. Near misses are events where no one was injured, but given a slight change in timing or action, someone could have been. ... Injury and Lost Time Incident Report. ... Exposure Incident Report. ... Sentinel Event Report.
How do I create an incident report template?
Incident Report Template Identify the type of incident and provide details of person of injury, job and hazard/incident. Take or attach photo evidence of incident, environment, person(s) involved. Gather witness statements and capture digital signature. Sign off with digital signature of person reporting.
How do I write an incident investigation report?
Step-by-step process to write an incident report Collect the information. The first step is to collect all the relevant information. ... Establish the order of events. Once you have collected all the information about an incident, you need to determine exactly what happened. ... Analyze the root cause. ... Formulate corrective action.
What are the elements of incident investigation?
Elements of an incident investigation include: preparation, on-site investigation and development of a report, with recommendations for prevention. Provide training to investigators, including management, workers, safety committee members and union representatives.
What are some important elements in an incident report?
It should include: the names and positions of the people involved. the names of any witnesses. the exact location and/or address of the incident. the exact time and date of the occurrence. a detailed and clear description of what exactly happened. a description of the injuries.
What are the four key elements of an incident investigation report?
Investigate the incident, collect data. Analyze the data, identify the root causes. Report the findings and recommendations.
What are the five steps of incident investigation?
Six steps for successful incident investigation STEP 1 – IMMEDIATE ACTION. ... STEP 2 – PLAN THE INVESTIGATION. ... STEP 3 – DATA COLLECTION. ... STEP 4 – DATA ANALYSIS. ... STEP 5 – CORRECTIVE ACTIONS. ... STEP 6 – REPORTING.
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