Free Accident Investigation Slip

Date and Time of Incident:

[Month Day, Year], [Time]

Location:

[Workshop Area, Building A]

Description of Incident:

[A machinery malfunction in the workshop led to an employee sustaining minor injuries while attempting a repair. Immediate actions included shutting down equipment and administering first aid.]

Names and Roles:

[Name], [Job Title]

Injuries:

[Name] - [Minor lacerations on hands, treated on-site.]

First Aid:

[Immediate first aid was administered by Emma Turner, who is trained in first aid. Minor lacerations on John's hands were cleaned, disinfected, and bandaged.]

Emergency Response:

[Workshop was evacuated promptly. Sarah Johnson notified emergency services. Fire extinguishers were ready, but not needed.]

Investigation Team:

[Name] - {Job Title]

[Name] - {Job Title]

[Name] - {Job Title]

Witness Statements:

[Name of Witness and First Aid Responder] reported that the machine emitted smoke before malfunction. [Name of Equipment Specialist] observed irregularities in equipment maintenance.

Photographs and Evidence:

Photos of the malfunctioning equipment, maintenance logs, and the scene. Diagrams showing the location of the incident and emergency exits.

Timeline of Events:

[Time] - Malfunction observed

[Time] - Workshop evacuation initiated

[Time] - First aid administered to John Smith

Immediate Causes:

[Machinery malfunction due to a lack of routine maintenance, leading to safety mechanisms failure.]

Underlying Causes:

[Inadequate training in equipment maintenance and lack of a comprehensive preventive maintenance program.]

Corrective Actions:

1. Implement a regular maintenance schedule for all machinery. 

2. Provide additional training for maintenance staff on equipment safety.

Training and Awareness:

Conduct monthly safety meetings emphasizing the importance of routine maintenance and emergency response procedures.

Implementation Timeline:

1. Maintenance schedule to commence on [Month Day, Year].

2. Training session scheduled for [Month Day, Year].

Monitoring and Review:

Monthly reviews during safety meetings, quarterly audits of maintenance records. Regular feedback sought from employees.