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5 step incident investigation report (DOCUMENT CONTROL (File Name,…
5 step incident investigation report
Investigation scope
• Consequence of interest
• Timeframe of interest
• Location of interest
• Equipment of interest
• People of interest
Collect information / Data
Environment
Equipment
People
3 Incident Details
3.1 Incident long description
Pre-Event:
Post Event:
3.2 INCIDENT KEY FINDINGS
3.3 INCIDENT CLASSIFICATION
Likelihood
A-Almost certain
B-Likely
C-Possible
D-Unlikely
Cosequence
1-Minor
2-Medium
3-Serious
4-Major
5-Catastrophic
Form and Test Hypothesis
4.1 AGREED HYPOTHESIS
Hypothesis
Supporting Observations
Rejecting Observations
Action
Agreed Corrective Action Description
Responsible Person
Hierarchy of control
/Due Date
Key Finding
Report Sign off
Name
Signature
Position
Lead Investigator
Contractor HSE Lead
*Jacobs Construction Manager
Contractor Area Superintendent
Contractor Area manager
*Jacobs HSE Manager
Owners Rep Manager
Owners Rep HSE
Date
DOCUMENT CONTROL
File Name
Description
Original Author(s)
Creation Date
Approved By
Approval Date
Change Record Number
Risk Ranking
Assessment Date
Risk Assessor
Review Schedule
Next Review Date
Version
Revision Date
Author(s)
Approved By
Revision Notes