Free Workplace Incident Investigation Rubric

Explore Workplace Incident Investigation Rubric Template on Template.net. This editable and customizable tool streamlines investigations. Designed to suit diverse workplace needs, it's editable in our Ai Editor Tool for seamless customization. Simplify incident analysis with this comprehensive template, ensuring thorough and efficient workplace safety protocols.

Incident Details
Date and Time	[Month Day, Year, Time]
Location	[Warehouse B, Section 4]
Brief Description	[Forklift overturned while maneuvering in a narrow aisle.]
Immediate Actions
First Aid/Medical Treatment	[First aid administered on-site; employee taken to hospital for further examination.]
Area Secured	[Yes]

Free Workplace Incident Investigation Rubric

1. Incident Classification

Type of Incident

Severity Level

2. Hazard Identification

Types of Hazards

Specific Hazards Identified

3. Cause Analysis

Immediate Causes

Underlying Causes

Contributing Factors

4. Witness Information

Witness Details

Interview Summaries

5. Evidence Collection

Types of Evidence

6. Risk Assessment

Likelihood of Recurrence

Impact on Health and Safety

7. Corrective Actions

Short-term Measures

Long-term Solutions

8. Follow-Up Actions

Implementation of Recommendations

Monitoring and Review

9. Reporting and Documentation

Report Quality

Documentation

10. Communication and Feedback

Communication with Parties

Feedback Mechanisms

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