Indiana Confidential Report of Accident Investigation

State:
Multi-State
Control #:
US-AHI-277
Format:
Word; 
Rich Text
Instant download

Description

This AHI form is a confidential accident investigation that is performed by the company once an injury has occurred.

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FAQ

Date, time, and specific location of incident. Names, job titles, and department of employees involved and immediate supervisor(s) Names and accounts of witnesses. Events leading up to incident.

Provide first aid for any injured person, Control the hazard(s) to prevent further injury, and. Secure the scene....OSHA suggests a 4-step approach:Preserve/Document The Scene.Collect Information.Determine The Root Causes.Implement Corrective Action.

Facts related to the incident include:The Basics. Identify the specific location, time and date of the incident.The Affected. Collect details of those involved and/or affected by the incident.The Witnesses.The Context.The Actions.The Environment.The Injuries.The Treatment.More items...?

How to Manage Incident & Accident Investigations in 4 Easy StepsPreserve and document the scene.Collect Data.Determine root causes.Implement corrective actions.11-Oct-2019

Keep in mind that these 3 considerations are not to be confused with the 3 requirements for writing an incident report:The report must be factual and without assumption.An incident report must be accurate and without bias.The incident report must be complete.

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.

The definition of an incident is something that happens, possibly as a result of something else. An example of incident is seeing a butterfly while taking a walk. An example of incident is someone going to jail after being arrested for shoplifting.

What Does an Incident Report Need to Include?Type of incident (injury, near miss, property damage, or theft)Address.Date of incident.Time of incident.Name of affected individual.A narrative description of the incident, including the sequence of events and results of the incident.Injuries, if any.More items...?27-Feb-2020

Provide the basic facts. Your form may have blanks for you to fill out with information about the incident. If not, start the report with a sentence clearly stating the following basic information: The time, date and location of the incident (be specific; write the exact street address, etc.). Your name and ID number.

Investigate the incident, collect data. Analyze the data, identify the root causes. Report the findings and recommendations.

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Indiana Confidential Report of Accident Investigation