The Incident Investigation Form is a crucial document required under Philippine workplace safety regulations, specifically designed to comply with Republic Act No. 11058 and DOLE Department Order No. 198-18. This form is essential for documenting and investigating workplace incidents, accidents, and near-misses in a systematic and thorough manner. It must be completed whenever an incident occurs that affects employee safety, property damage, or operational disruption. The document includes detailed sections for incident description, witness statements, root cause analysis, and corrective actions, serving as both an immediate response tool and a record for future reference and regulatory compliance. It helps organizations maintain proper documentation for insurance claims, workers' compensation, and government reporting while supporting continuous improvement in workplace safety practices.
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1. Incident Basic Information: Essential details including date, time, location, and type of incident
2. Reporter Information: Details of the person reporting the incident, including name, position, and contact information
3. Incident Description: Detailed narrative of what occurred, including sequence of events and immediate actions taken
4. Affected Persons: Information about all persons involved in or affected by the incident, including employees, contractors, or visitors
5. Witness Information: Details of witnesses, including names, contact information, and initial statements
6. Environmental Conditions: Description of workplace conditions at the time of incident (lighting, weather, equipment status, etc.)
7. Root Cause Analysis: Investigation findings on direct and underlying causes of the incident
8. Immediate Actions Taken: Description of immediate response actions and emergency measures implemented
9. Corrective Actions: Detailed preventive and corrective measures to be implemented to prevent recurrence
10. Investigation Team: Names and roles of personnel conducting the investigation
1. Medical Report Section: Detailed medical information and treatment details when incident results in injury
2. Property Damage Assessment: Detailed evaluation of damage to equipment, facilities, or materials when applicable
3. Environmental Impact: Assessment of environmental effects for incidents involving spills, emissions, or other environmental concerns
4. Third Party Involvement: Additional section for incidents involving external parties or contractors
5. Cost Impact Analysis: Financial assessment of incident impact when significant costs are involved
6. Legal Compliance Review: Additional section for incidents requiring specific regulatory reporting or legal review
1. Appendix A - Photographic Evidence: Photographs, diagrams, or sketches of the incident scene and relevant details
2. Appendix B - Witness Statements: Detailed written statements from witnesses
3. Appendix C - Related Documents: Relevant documentation such as maintenance records, training records, or procedures
4. Appendix D - Risk Assessment: Pre-incident risk assessments and post-incident risk evaluation
5. Appendix E - Medical Reports: Copies of medical certificates or reports if applicable
6. Appendix F - Investigation Timeline: Detailed timeline of events before, during, and after the incident
7. Appendix G - Action Tracking Sheet: Template for tracking implementation of corrective actions
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