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Report Incident

Details of the incident/near miss

Details of the incident/near miss investigation

Witness details

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Name of person/s conducting investigation

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Immediate causes / Contributing Causes that may have been a factor to the accident/incident

Full description of events

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Incident / Near miss investigation form

The reason for investigating an incident or near miss is to determine: the cause or causes of the incident; to identify any risks, hazards, systems or procedures that contributed to the incident; and to recommend corrective action to prevent similar incidents.

Incidents should be investigated by people knowledgeable about the type of work involved at the time of the incident. Relevant workers should also be involved in the investigation.

An incident/near miss investigation report should answer the WHO, WHERE, WHEN, WHAT, WHY and HOW questions with regard to an incident.