Conducting
an Accident Investigation
Course 102
Safety Certified Supervisor Series
MODULE 7: WRITING THE REPORT
The Accident Report
Form
- Section I.
Background
- Section II.
Description of the accident
- Section III.
Findings
- Section IV.
Recommendations
- Section V. Summary
- Section VI.
Review and Follow-Up Actions
- Section VII.
Attachment
Section III. Findings
(continued)
- Sample
primary surface cause finding statements
- Sample secondary surface cause
finding statements
- Sample safety program implementation
root cause finding statements
- Sample safety program design
root cause finding statements
The findings describe the hazardous
conditions and unsafe behaviors that directly caused injury. They exist or
occur immediately prior to the injury event.
- Hazardous condition:
The bolts for the machine guard on the chipper were missing and the grating
cut open.
- Unsafe behaviors: The
injured employee fed limbs into the unguarded chipper, exposing himself
to the hazardous condition.
