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SF001
                                           Accident Investigation Form                                  Issue 1
                                                                                                     03/09/2012


             16. Causes

             Immediate Causes (please tick most applicable boxes) ✓
              Substandard Acts                                 Substandard Conditions
              1.   Fighting / horseplay                        1.   Adverse underfoot conditions
              2.   Ignoring / disregarding warning / hazard      2.   Adverse visibility
              3.   Inadequately performed maintenance task      3.   Adverse weather conditions
              4.   Inappropriate / inadequate clothing         4.   Congestion or restricted action / access / egress
              5.   Inappropriate loading / securing of vehicle      5.   Defective infrastructure
              6.   Inappropriate placement / positioning       6.   Defective vehicle / tool / equipment / material
              7.   Inappropriate use of Personal Protective Equipment      7.   Inadequate / excessive illumination
              8.   Inappropriate use to tool / equipment / vehicle      8.   Other hazardous environmental conditions
              9.   Incorrect manual handling                   9.   Other substandard condition
              10.  Maliciousness
              11.  Miscommunication
              12.  Misjudgement
              13.  Observance of rules / instructions / SSoW
              14.  Other inadequate performance of duties
              15.  Other inappropriate use of tool
              16.  Other substandard act
              17.  Servicing / monitoring of – when in operation
              18.  Taking inappropriate route
              19.  Use of – without authority
              20.  Use of – improperly
              21.  Use of – inappropriate for task
              22.  Use of – when defective
              Others:                                          Others:


             Basic or Underlying Causes (please tick most applicable boxes) ✓
              Substandard Acts                                 Substandard Conditions
              1.   Improper motivation                         1.   Abuse or misuse
              2.   Inadequate mental / psychological capabilities       2.   Inadequate engineering
              3.   Inadequate physical / psychological capabilities      3.   Inadequate maintenance
              4.   Lack of knowledge                           4.   Inadequate purchasing
              5.   Lack of skill                               5.   Inadequate tool / equipment / material
              6.   Stress – mental / psychological             6.   Inadequate work standards
              7.   Stress – physical / psychological           7.   Wear and tear
              8.      Insufficient/ incorrect information       Others:
               Others:

















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