PREP-- Accident Investigation Form for Employees,
Buildings and Collections
This form is intended to help organize the investigation of accidents
and incidents involving employees, equipment, buildings and collections.
All accidents and incidents should be investigated, no matter how minor.
The same conditions that cause a minor incident could lead to a major
accident. The form is structured to help determine the fundamental cause
of the accident, so that effective corrective action can be taken.
The following steps will help you investigate an accident and fill out
the form:
1. Discuss the accident with the employee involved, and with
any witnesses. Be sure to question the why-what-where-when-who-how
aspects of the accident.
2. Inspect the equipment or materials involved for conditions
that could be made safer.
3. Study the job set-up and process of doing the work. Could
it be improved?
4. Is the employee involved suited for the job he/she is doing?
Did he/she receive adequate training? Are there any other contributing
problems--use of drugs, use of alcohol, or emotional problems?
5. Recommendations to correct the problem must be practical.
Be sure your recommendations will not create other situations that
could result in injury to employees or damage to property.
6. Complete your report no later than the next working day after
the accident.
Part I -- General Information
Who was involved?____________________________ Age _____ Dept _______________
Date of accident________________________ Hour ________
a.m.
p.m.
