SUPERVISOR'S ACCIDENT INVESTIGATION REPORT - CONSTRUCTION

Construction Safety Accident Investigation

Project Information

Project Name(Required)

Project Location(Required)

Date of Accident(Required)

Time of Accident(Required)

Incident Description

Brief Description of the Incident(Required)

Type of Incident (e.g., fall, equipment failure, struck by object)(Required)

Weather Conditions(Required)

Injuries and Damages

Injured Individuals

Name

Position

Injury

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Property Damage (if any)

Witnesses

Name

Contact Information

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Immediate Response

What immediate actions were taken?(Required)

Who was notified of the incident?(Required)

Root Cause Analysis

Contributing Factors

Lack of training(Required)

Yes

Inadequate safety equipment(Required)

Yes

Poor communication(Required)

Yes

Other (please specify)(Required)

Root Causes Identified:(Required)

Corrective Actions

Recommended Actions to Prevent Future Incidents(Required)

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Follow-Up Actions

Responsible Person(s) for Follow-Up(Required)

Deadline for Completion of Actions(Required)

Investigation Team

Names of Investigation Team Members

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Summary and Recommendations

Overall Summary of Findings(Required)

Final Recommendations(Required)

Signatures

Investigator Name(Required)

First Last

Date(Required)

Investigator Signature(Required)

Supervisor/Manager Name(Required)

First Last

Date(Required)

Supervisor/Manager Signature(Required)