What is an Incident Investigation Form?

An Incident Investigation Form is a structured document used to record details about an incident, including what happened, who was involved, and any immediate actions taken. This form helps organizations analyze incidents to prevent future occurrences. Using airSlate SignNow, you can easily create and manage your Incident Investigation Forms digitally.

How can airSlate SignNow help with Incident Investigation Forms?

airSlate SignNow streamlines the process of creating, sending, and signing Incident Investigation Forms. With its user-friendly interface, you can quickly customize forms to fit your organization's needs. Additionally, the platform ensures that all forms are securely stored and easily accessible for future reference.

Is there a cost associated with using airSlate SignNow for Incident Investigation Forms?

Yes, airSlate SignNow offers various pricing plans to accommodate different business needs. Each plan includes features that support the creation and management of Incident Investigation Forms. You can choose a plan that best fits your budget and requirements, ensuring you get the most value for your investment.

What features does airSlate SignNow offer for Incident Investigation Forms?

airSlate SignNow provides a range of features for Incident Investigation Forms, including customizable templates, electronic signatures, and real-time tracking. These features enhance the efficiency of your incident reporting process. Additionally, you can integrate the forms with other tools to streamline your workflow.

Can I integrate Incident Investigation Forms with other software?

Absolutely! airSlate SignNow allows seamless integration with various software applications, making it easy to incorporate your Incident Investigation Forms into your existing systems. This integration helps maintain consistency and improves data management across platforms.

What are the benefits of using airSlate SignNow for Incident Investigation Forms?

Using airSlate SignNow for Incident Investigation Forms offers numerous benefits, including increased efficiency, reduced paperwork, and enhanced compliance. The platform's digital solution ensures that forms are completed and signed quickly, minimizing delays in incident reporting. This ultimately leads to a safer workplace.

How secure are the Incident Investigation Forms created with airSlate SignNow?

Security is a top priority for airSlate SignNow. All Incident Investigation Forms are protected with advanced encryption and secure storage solutions. This ensures that sensitive information remains confidential and is only accessible to authorized personnel.

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Incident investigation form 22993912

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ACCIDENT / INCIDENT INVESTIGATION REPORT FORM Employee Name: _______________________________________ Dept: _________________________ Date & Time Accident/Incident Reported: _____ / _____ / _____ @ ______: ______ AM / PM MM DD YY Date & Time Accident/Incident Occurred: _____ / _____ / _____ @ ______: ______ AM / PM MM DD YY Location of Accident/Incident: ___________________________________________________________ Vehicle Involved: No Yes ______________________ __________________________ Vehicle ID Number Police Report: Photos: No No Yes Date of Last Vehicle Inspection Yes # ________________________ Name of HR Representative Notified: _____________________________ Supervisor’s Report of Accident/Incident Describe in Detail What Happened: ________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Why Did the Incident/Accident Occur? _____________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Nature of Injury, Injury Type and Part of Body Affected: ______________________________________ Contributing Factors: Environmental (Noise, Vapors, Light, Heat, Critters, etc…) Design (Workplace Layout, Design of Tools and Equipment) System & Procedures (Lack of or Inappropriate Systems and Procedures) Human Behavior Comments: ___________________________________________________________________________ How was the employee trained for performing this job task? _____________________________ ______________________________________________________________________________ ______________________________________________________________________________ What is the safety procedure for this job? ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What will be done in the interim and in the future to prevent this type of Incident/Accident? ___________ _____________________________________________________________________________________ _____________________________________________________________________________________ Please check below what is applicable: I have reviewed the employee’s statement and interviewed witnesses listed in the employee’s report. I have discussed this completed report with the employee before turning it into the Department Head. Date: ______________________ I have not discussed this completed report with the employee before turning it into the Department Director for the following reason: _________________________________________________________ I have informed the employee that this accident/incident may be reviewed by the Accident Review Committee. _____________________________________________ ________________________ Reporting Supervisor’s Signature Date _________________________________________________ __________________________ Department Director’s Signature Date Employee’s Report of Accident/Incident The purpose of this report is to help us prevent future accidents/incidents from occurring and may be used by the Accident Review Committee. Date & Time Accident/Incident Occurred: _____ / _____ / _____ @ ______: ______ AM / PM MM DD YY Who else was with you or witnessed the accident/incident when it occurred? ________________ ______________________________________________________________________________ What were you doing at the time the accident/incident occurred? _________________________ ______________________________________________________________________________ ______________________________________________________________________________ What happened? ________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ How do you think the accident/incident occurred? _____________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Nature of Injury, Injury Type and Part of Body Affected: ______________________________________ _____________________________________________________________________________________ How were you trained for performing this job task? ____________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What is the safety procedure for this job? ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ What Personal Protective Equipment (PPE) were you wearing at the time of the accident/incident? ______________________________________________________________ ______________________________________________________________________________ I did/will seek medical treatment for this accident/incident. I did not/will not seek medical treatment for this accident/incident at this time. If I decide to seek treatment at a later date for this accident/incident, I understand that I need to call 1-877676-3890 for authorization. I understand that if I have sustained an injury/illness due to this accident/incident, I am required to report it immediately to my supervisor so that I can be treated at a facility authorized by the City’s Workers’ Compensation insurance. I further understand that I am responsible for reporting injuries/illnesses to Workers’ Compensation by calling 1-877-676-3890. __________________________________________________ Employee’s Signature __________________________ Date Employee’s Printed Name: ______________________________________________________ Witness’s Report of Accident/Incident Date & Time Accident/Incident Occurred: _____ / _____ / _____ @ ______: ______ AM / PM MM DD YY Location of Accident/Incident: ___________________________________________________________ Vehicle(s) Involved: No Yes _____________________________________________________ Description of vehicle(s) Please provide any information you have that may be helpful in the investigation of the incident/accident you witnessed. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Printed Name: ________________________________________________________________ Contact Information: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________ Signature ________________________ Date

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