FREE 6+ Accident Investigation Form Samples in PDF | MS Word

The workplace is not only a place where employees do their tasks and compete for a promotion but its also where accidents can occur at any time. This is the reason why the HR department must be prepared with regards to documenting any incident by using accident investigation forms.

• Accident Report Forms in PDF
• Sample Accident Report Forms

Accident Investigation Form Sample

What is an Accident Investigation Form?

An accident investigation form is a document that is used by the human resource personnel and the head officials of a company to gather evidence, details, and matters that are related to an accident that occurred in the company’s workplace. The form must be used along with the accident report that the employee or the witness submitted to inform the management about the accident. With these documents, the company will be able to address an action plan to ensure that the accident will never again occur in the business’s premises and that the employees or the staff of the company will be safe throughout their working schedules.

School Employee Accident Investigation Form

Varieties of Accident Investigation Forms

There are different varieties and types of accident investigation forms that can be created and prepared by any company management. Below are some of the common varieties of accident investigation forms:

1. Accident Investigation Report Form – This form has similar sections to a basic accident report form; however, it has additional areas where the identities and the recommendations of the investigating party will be disclosed and specified. Some of the contents and inclusions that are found in this form are the user’s general information which is his name, address, job position, and even his schedule.

The contact details of the injured employee and the description of the accident are the sections that are stated following the information of the user. In addition to this, a questionnaire is also incorporated in the form wherein the user will be able to inform the company and the investigator of whether a first aid protocol was conducted for the injured employee and if there are witnesses during the accident or not. You may also see sample complaint investigation forms.

Accident Investigation Report Form

2. Accident Near Miss Investigation Form – Even if an uneventful incident did not result to anyone’s injury or the destruction of a property, it should still be reported to the company’s management and human resource personnel. This is when an accident near miss investigation form will be used by the management to determine the causes of the incident. The form allows the user or the investigator to state details of the near miss accident and jot it down on a section where it is categorized such as due to a machinery or an office equipment. You may also see complaint investigation forms.

The user of the form can also state if the person involved in the accident was wearing a personal protective equipment during the incident or not, and if the person involved followed the procedure mandated by his supervisor in completing his tasks or have violated the rules of the company regarding safety and security. To further lay out the accident’s details, the investigator or the user of the form must enclose other documentation such as photographs of the accident scene, drawings and diagrams of the machinery causing the accident, and witness statements from the employees who have seen the accident. You may also see sample employee misconduct forms.

Accident Near Miss Investigation Form

3. Insurance Accident Investigation Form – Every business company must have an insurance policy that focuses on contributing to the costs and fees for events of accidents and near miss incidents. If an accident occurs in the company, the management must complete an insurance accident investigation form that is not only to be used internally but also for the insurance providers of the company if there is a need to supply a proof or evidence that an accident indeed happened within the company’s premises. The form consists of three sections namely the accident information section, contributing factors section, and the list of corrective actions taken by the company. You may also see accident report forms.

The accident information section should have the accident’s description, time, location, and the names of the employees and non-employees who were involved in the accident. The contributing factors section, on the other hand, will distinguish what actions and conditions in the company’s workplace that is the root cause of the accident. Lastly, the corrective actions list should contain what the human resource personnel and the management of the company conducted as a procedure after the accident along with the identifications of the persons in charge for each planned corrective action.

Insurance Accident Investigation Form

4. Supervisor Accident Investigation Form – This document is only allowed to be completed and submitted by the company department’s supervisor where the accident occurred or where the employees are assigned to do their tasks and obligations. This form is accompanied by other documents such as an employee report form, an accident witness statement form, and an information sheet which are all significant for gathering facts and details about the accident.

Supervisor Accident Investigation Form

Simple Accident Investigation Form

How to Create a General Accident Investigation Form

Making an accident investigation form from scratch is easy especially with the guide or the steps enlisted below:

Step 1: Indicate the Title of the Document and the Basic Information of the Organization or Company. The title “Accident Investigation Form” must be stated at the topmost area of the form which will be followed by the name of the company, its contact information, and its company address.

Step 2: Allocate a Section for the Particulars of the Accident. This section should be where the basics of the accident will be disclosed by the investigator or user of the form such as the date and time of the accident, and the date when the accident was reported to the company’s authorized personnel. You may also see sample incident report forms.

Step 3: Have a Section for the Details of the Injured Party. The name and address of the injured employee should be stated in this section along with his emergency contact person’s information to ensure that the company will be able to reach out to the representative of the injured employee whenever possible. Additionally, the employee’s date of birth, and the employment length or the date when he was hired in the company can also be included to determine what type of insurance coverage he is eligible to acquire if there are any.

Step 4: Integrate Checklist Boxes to Determine the Type of Injury Acquired. Whether it’s a bruise, dislocation of the joints, or a sprain, it should be defined correctly in the investigation form, which is why a set of checklist boxes that has different varieties of injuries is necessary to be incorporated in the form. The comments and the statements of the injured employee can also be included to collect details about the injury and what specific part of the body needs to be treated immediately by the company’s first aid providers. You may also see incident report form examples.

Step 5: Add a Section for the Description of the Damaged Property. Commonly, accidents in the workplace are due to misplaced wires and even fallen debris of unfinished walls and ceilings. This is why an accident investigation form must clearly state what damages are evident in the company’s properties where the accident occurred. The nature of the damage and the substance or the factor that contributes to the property’s damages are significant to be defined as well. You may also see accident information form.

Step 6: Indicate a Blank Section for the Details of the Accident. This section should be wide enough to allow the user in making a diagram or drawing of the incident and narrating the events that lead to the involvement of the employees in the company. Questions that can help investigators to gather more details can also be beneficial when included in the form as long as it will still allow the user to have tons of blank spaces for him to disclose his answers and thoughts. You may also see incident report forms.

Step 7: Have an Analyzation and Prevention Section. This is where the user or the investigator will be able to state their own thoughts from the facts presented to them by the witnesses. The step-by-step incidents, how serious the accident is, and how often it would likely happen in the company’s premises are some of the analyzation that the investigator needs to focus on. In addition to analyzed output, the investigator must also key in suggestions and regulations of how the company can avoid dealing with the same issue in the near future as well as to keep the company accident-free and employee-friendly. You may also see free incident report forms.

Step 8: Add a Section for the Treatment and Investigation Information. This section focuses on what was given to the injured employee, from first aid attention to medications, and the identities of the medical providers who helped the employee. The name of the investigator and the date of when the investigation was conducted are also essential to be stated in this part of the investigation form. You may also see sample safety report forms.

Aside from the contents mentioned in the steps above, a company can also incorporate other data fields wherein the user will be able to disclose more information about the incident to help the company and the investigators. Nevertheless, the completed accident investigation form must be kept confidential at all times especially during the investigation period, along with other documents that are used for resolving the concerns in the company’s workplace. You may also see sample accident statement forms.