Safety Investigation Form
Complete this form during the investigation of any complaint, issue, finding, accident, or incident - any time an investigation is needed.
Email
example@example.com
Incident Name
Name of Safety Team Member Conducting Investigation
First Name
Last Name
Date of Incident
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Person Who Reported Incident
First Name
Last Name
Summarize the details of the complaint/incident below. Please be as descriptive and detailed as possible.
List all the findings in your investigation below.
Did you find a violation in our current safety policy? If so, what kind?
Please provide the names and titles of all people who were interviewed during this investigation.
What corrective measures are in place or need to be put in place to ensure a problem like this does not occur again? When will these changes be implemented?
How will we educate all employees about the findings of this investigation and any resulting changes to prevent recurrence?
Name
First Name
Last Name
Signature
Continue
Continue
Should be Empty: