Construction Incident Investigation Report
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Business Negocio report informe Name Nombre Incident Incidente Construction Incident Report Informe de incidente de construcción Not No Injury Lesión Improper Incorrecto
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Describe who was involved, when and where the incident happened, what happened, and how.) Company Name/Logo: Incident Reporting and Investigation Form 10/12/10, Page 2of 3 Why did it happen (Root Cause Analysis) (What was the root cause of the incident, i.e., actually caused the illness, injury, or incident ) Unsafe Acts Unsafe Conditions Management System Deficiencies Improper Work Technique Poor Workstation Design or Layout Improper PPE, Not Used or Used Incorrectly Fire or Explosion Hazard Safety Rule Violation Congested Work Area Operating Without Authorization Hazardous Substances Failure to Warn or Secure Inadequate Ventilation Operating at Improper Speeds Improper Material Storage By-Passing Safety Devices Improper Tool or Equipment Guards Not Used Insufficient Job Knowledge Improper Loading or Placement Slippery Conditions Improper Lifting Poor Housekeeping Servicing or Adjusting Machinery in Motion Excessive Noise Horseplay Inadequate Guarding of Hazards Drug or Alcohol Use Defective Tools/Equipment Unsafe Act(s) of Others Insufficient Lighting Unnecessary Haste Inadequate Fall Protection Other: Other: Lack of Written Procedures or Safety Rules Safety Rules Not Enforced Hazards Not Identified PPE Unavailable Insufficient Worker Training Insufficient Supervisor Training Improper Maintenance Inadequate Supervision Insufficient Job Planning Inadequate Hiring Practices Poor Process Design Inadequate Workplace Inspections Inadequate Equipment Unsafe Design or Construction Unrealistic Scheduling Other: List immediate actions taken and results..
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