Forms, Reports, Checklists
Sample Employee Accident/Incident Investigation Report Form
Under Minnesota AWAIR (A Workplace Accident and Injury Reduction) program standards, organizations are required to investigate workplace incidents to determine causes, take corrective actions and prevent future incidents. The depth and quality of these investigations depend on how thorough and seriously investigators take their responsibility.
This sample form seeks to improve the quality of incident investigations by prompting supervisors, department heads and others to ask applicable questions to determine the root causes of the incident. The report seeks to provide information when filing a workers’ compensation claim and provide claim representatives with necessary information to process claims more efficiently.
When gathering information, remember that the goal of the investigation is to determine what happened so that it can be prevented from happening again. It is not to find fault or assign blame.
Near Miss Investigations Contribute to a Positive Safety Culture
When employers investigate near miss incidents, they signal to employees that safety is a priority. When employees know that management values safety, they take it more seriously and make decisions in favor of safety.
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