Annexure B

Incident Investigation Report Outline

(To be used for Level 2 Incidents and all other incidents which are internally being investigated Investigation
Teams. However for Level 3-Major Incidents

1. Contents of Incident Investigation Report:

. Title Page
.
Table of Contents
Executive Summary
Terms of Reference
Incident Description
Discussion of the Evidence and Losses
Critical factors contributing to the incident occurrence
Immediate Causes
R o o t C a u s e s
Recommendations to Prevent Recurrence
2. Appendices:
Diagrams and Photographs (Positions)
Documentation (Papers/Parts)
Interviews (People)
. Copy of the MyHSSE report
~ Non-contributory factors (if any)

3. A brief outline of the requirements for each part of the report are given
below:

3.1 Title Page ‛ Includes title, location and date of the incident and date of the
report and the accident and incident database reference.

3.2 Executive Summary ‛ 'High-level' summarized description of the incident,

highlighting significant findings/ conclusions and referencing the Investigating

3.3 Table of Contents ‛ A listing of the report contents and page numbers.

3.4 Terms of Reference ‛ A formal document that defines the scope of an

investigation for an incident, identifies references, provides objectives /
guidance and lists the committee members and Incident Owner.

3.5 Incident Description ‛ A description of the situation (sequence of event)

before the incident, what happened during the incident, and actions taken after
the incident? The questions who, what, where and when must be answered.

3.6 Discussion of the Evidence & Losses ‛ This section should take the reader
through the logical discussion of the evidence that leads to the
conclusion of immediate causes.