Incident Investigation Report Example
Example document for Incident Investigation Report. Use this as a reference when creating your own.
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Document: Incident Investigation Report
Example Document
Last updated 7/29/2026
Incident Investigation Report
1. Incident Details
Date of Incident: 12/10/2023 Time of Incident: 09:15 AM Date Reported: 12/10/2023 Time Reported: 09:20 AM Location: 4 Smith Street, Construction Site, Zone 3 Weather Conditions: Clear and dry
2. People Involved
Injured Person(s):
- Name: John Smith
- Job Title: Labourer
- Injury/Illness Description: Deep laceration to left forearm
- Part of Body Affected: Left arm
- Treatment Provided: First aid on site followed by transport to Brisbane Hospital for stitches
Witnesses:
- Mark Jones, Site Supervisor
- Sarah Lee, Electrician
Investigator Details:
- Name: David Brown
- Position: Safety Officer
- Date of Investigation: 12/10/2023
3. Description of Incident
Immediate Cause: The worker struck his arm on an exposed sharp edge of metal ducting while carrying materials.
Sequence of Events: At approximately 09:15 AM, John Smith was carrying a box of tools through the corridor in Zone 3. As he turned a corner, his arm brushed against a piece of metal ducting that had been temporarily installed the day before. The metal had been cut with an angle grinder and the edge was left sharp and exposed. John was wearing standard long sleeve work shirt but the sharp edge cut through the fabric. He dropped the tools and called for help. Mark Jones applied pressure to the wound and called an ambulance.
4. Investigation Findings
Environmental Factors: Lighting was adequate. The corridor was narrow but clear of debris. Equipment Involved: Galvanised steel ducting, approximately 1 metre in length. Procedures in Place: There is a general site procedure for handling materials, but no specific procedure for the temporary storage of ducting. No signage was present warning of the sharp edge. Training: John has completed general site induction. PPE Worn: Safety boots, long sleeve high-vis shirt, hard hat, safety glasses.
5. Root Cause Analysis
Why did it happen? John brushed against a sharp metal edge. Why was the edge exposed? The ducting was cut and left without filing or capping the edge. Why was it left there? The installation team ran out of edge protectors and planned to apply them the next day. Why was it not guarded? The team did not erect a temporary barrier or tape to keep workers away from the hazard.
6. Immediate Actions Taken
- Site Supervisor Mark Jones administered first aid and called emergency services.
- David Brown isolated the area and erected caution tape around the ducting.
- All workers in the area were notified of the hazard.
7. Corrective Actions to Prevent Recurrence
| Action Required | By Whom | Target Date | Status |
|---|---|---|---|
| File or cap the sharp edge of the ducting immediately | Installation Team | 12/10/2023 | Complete |
| Issue a 'stop work' order on any temporary sharp edges left unattended | David Brown | 12/10/2023 | Complete |
| Update site SWMS to include requirements for guarding sharp edges | David Brown | 15/10/2023 | Pending |
| Toolbox talk with all staff regarding temporary hazards | Mark Jones | 13/10/2023 | Pending |
8. Sign-off
Investigator Signature: D. Brown Date: 12/10/2023
Manager/PCBU Signature: A. White Date: 13/10/2023
Notes
This example demonstrates a clear objective account of the event. The investigator identifies not just the injury, but the physical object involved. The root cause analysis uses the '5 Whys' technique effectively to trace the problem back to a lack of procedure and supplies, rather than blaming the injured worker. The corrective actions are specific, assigned to a person and have a deadline.
About this Example
Part of the Incident Investigation Report document collection
Document Type
Incident Investigation Report
A formal record used to document the details of a workplace accident, near miss or hazardous event to determine the cause and prevent future occurrences.