The Incident Investigation Form is a crucial document required under New Zealand's health and safety legislation, particularly the Health and Safety at Work Act 2015. This document must be completed following any workplace incident, accident, or significant near-miss to document the event, identify root causes, and determine preventive measures. The form supports compliance with WorkSafe NZ reporting requirements and ACC claims processes while providing a structured approach to incident investigation. It captures essential information including incident details, witness statements, investigation findings, and corrective actions, serving as both a legal record and a tool for organizational learning and risk management. The document is designed to be comprehensive enough to meet regulatory requirements while remaining practical for use across different industry sectors and organizational sizes.
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1. Incident Details: Basic information including date, time, location, and type of incident
2. Person(s) Involved: Details of all people involved including injured parties, witnesses, and investigators
3. Incident Description: Detailed narrative of what happened, including sequence of events
4. Immediate Actions Taken: Steps taken immediately after the incident to secure the scene and ensure safety
5. Investigation Findings: Analysis of root causes, contributing factors, and investigation methodology
6. Evidence Collected: List and description of physical evidence, photographs, documents, and witness statements
7. Risk Assessment: Evaluation of the risk level and potential consequences
8. Corrective Actions: Specific actions required to prevent recurrence
9. Notifications: Record of required notifications to authorities (e.g., WorkSafe NZ, ACC)
10. Sign-off: Approval and verification by relevant authorities (manager, H&S representative)
1. Environmental Impact Assessment: Required when incident involves environmental damage or potential contamination
2. Equipment/Machinery Investigation: Detailed analysis when incident involves equipment failure or malfunction
3. Contractor Management: Required when incident involves contracted workers or services
4. Return to Work Plan: Required for incidents resulting in injury requiring time off work
5. Cost Analysis: Assessment of financial impact when significant property damage or business interruption occurs
6. Drug and Alcohol Testing Results: Required when substance testing was conducted as part of investigation
1. Witness Statement Forms: Template forms for recording witness accounts
2. Scene Diagram Template: Grid paper and guidelines for sketching incident scene
3. Risk Matrix: Standard risk assessment matrix for evaluating incident severity and likelihood
4. Notification Requirements Checklist: List of authorities to be notified based on incident type
5. Investigation Methodology Guide: Standard procedures and methods for conducting investigation
6. Evidence Collection Checklist: Standardized list for ensuring all relevant evidence is gathered
7. Corrective Action Register: Template for tracking implementation of corrective actions
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