University of St. Andrews

Accident/Incident Investigation Report

1.	Details of the Accident/Incident

	School/Unit/Residence  ................................................................................

	Date/Time of Accident  ............................................  20 ......  am/pm  ........

	Name of Person(s) Involved  ........................................................................

	Place of Accident/Incident  ...........................................................................

	Name of Investigator  ....................................................................................

	Date of Investigation  ....................................................................................

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2.	DETAILS  OF  WHAT  HAPPENED

a.	Historical Evidence (Timing and sequence of events)

b.	Describe the process being undertaken when the incident happened

c.	Provide copies of the risk assessment for the work activity and the relevant control measures which should have been in place and also any Safe Systems of Work which should have been followed. 
Was the risk assessment/Safe System of Work adequate and if not, why not

d.	Possible causes of the incident

CAUSITIVE AGENT (Tick more than one option if applicable)	
Live Animal	
	Falls from height		Hot/cold contact		Violence/Assault		
Electricity		Struck or trapped by object		Defective premises		Defective equipment		
Explosion	
	Striking against fixed or stationary object		Exposure to toxic substances or pathogenic material		Work-related vehicle/traffic accidents		
Fire								
Falls on level		Sharps (incl. Glass & needles		Unintentional spillages/releases of harmful substances		Occupational Illness		
Falls on stairs		Handling/Lifting				Other		

These are just examples of possible causative agents. If the incident did not involve any of these, please add the risk to the table.

e.	Geographical Evidence (Take measurements of relevant items, objects and equipment involved. If deemed useful, take photographs and make scale drawings).

f.	Other underlying causes which may have been a factor min the incident (for example; poor management/supervision, poorly designed process, poor maintenance, lack of proper training., poor communication, lack of suitable and sufficient personal protective equipment)

d.	Circumstantial Evidence. (Where there is no witness to establish a conclusion).

3.	Conclusion (From the evidence give reasons for accident/incident  and also the underlying causes and ‘Root Causes’ of the incident e.g. failure of plant or equipment, human error, inadequate training, lack of supervision, lack of a safe system of work etc).

4.	Recommendations (Measures to prevent recurrence of accident/incident. Counselling - Victim/Witness)

Recommendation number	Underlying causes of the incident	Recommendations for remedial action	Person responsible for implementing remedial actions	Proposed date remedial actions to be completed by	When remedial actions completed	

						

Send Report to Head for attention/action
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Head of School/Unit/Residence - Remarks