Incident Investigation Checklist
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A s e r i e s o f h e a l t h a n d s a f e t y t i p s t o p r e v e n t w o r k- r e l a t e d i n j u r i e s i n t h e t r u c k i n g i n d u s t r y
Incident Investigation Checklist
Ask why? Use the categories below to get started. Keep asking why until you find the source of the incident.
Equipment
Employee
ˆ Tractor
Did the equipment
ˆ Are there written procedures for the task to be
accomplished, if so, was the employee provided training?
contribute to the incident
ˆ Trailer
through a failure, lack
ˆ Is the employee physically capable of carrying out the
ˆ Liftgate
of feature or lack of
tasks?
ˆ Pallet jack
maintenance?
ˆ Did the employee wear the appropriate personal
ˆ Hand truck
protective equipment (PPE)?
ˆ Other__________________
ˆ Is enough time allowed for workers to do their tasks
Comments on equipment:
correctly and safely so that they aren’t tempted to take
shortcuts?
Comments on employee:
Environment
ˆ Light
Did the environment
ˆ Dark
Management
contribute to the incident?
ˆ Wet
ˆ Is management trained in hazard recognition?
ˆ Heat
ˆ Did management anticipate the hazard and the risk?
ˆ Cold weather or ice
ˆ Was management aware that a deviation from safety
ˆ Uneven ground
procedures might occur and take steps to prevent it?
ˆ Indoors
ˆ Is management’s role in hazard recognition and corrective
ˆ Outside
action clearly defined and assigned?
Comments on management:
ˆ Visibility (fog or shadows)
ˆ Windy
ˆ Other___________________________________________
Other issues noted:
Comments on environment:
Root Cause (Source) of Incident:
Ultimately, what conditions could have been changed to prevent the incident?
Next Steps
General Category
Specific Task
Owner of
Date
Task
Completed
Repair or replace equipment
Develop environmental solution (for example: correct light-
ing, develop process to sand yard during icy conditions)
Train employees
Train management
Signature_________________________________________________________Date__________________
SHARP Program, Dept. of Labor & Industries
Phone: 1-888-667-4277
Publication No. 90-81b-2011
Companion document 90-81a-2011 How to investigate an incident.
E-mail:
December 2011
Produced by the Trucking Injury Reduction Emphasis (TIRES) Project with funding in part from CDC/NIOSH grant U60 OH008487.
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Parent category: Life