Page 55 - On Call folder
P. 55
SF001
Accident Investigation Form Issue 1
03/09/2012
12. Description of Accident/ Incident (continue on separate sheet if necessary)
13. Line Manager / Supervisor Comments & Remedial (Short Term & Long Term) Actions
(Continue on separate sheet if needed)
14. Injured / Involved Persons Comments as to How Accident/ Incident Could Have Been Prevented
(Continue on separate sheet if necessary)
15. Actions
What positive Briefing on correct tools No appropriate action Staff disciplined / briefed
actions have Hazard eliminated Safe system of work introduced Training required
been taken to
prevent Hazard repaired / replaced Safe system of work modified Other (specify below)
reoccurrence? Maintenance procedures reviewed Staff counselled
Page 1 of 6
Please send all completed forms back to PHoSS Page 4 of 6
S:\Resource Management\On-Call\On-Call Folder 5.6.18\9. AccidentIncident Near Miss Reporting & Investigation\SF001 Accident Investigation Form Issue No 01 03-09-2012.docP Page 4 of 6
Uncontrolled copy once printed from its electronic source
