Incident Investigation Report

Employee Legal Name Gender Country of Origin Date of Birth Age Volunteer?

Canada
Mailing Address WorkSafeBC Case Number

Local Address Same as Mailing? Length of Service Length of Service in Department

Years Months Years Months
Department Ski Area Province

BC
Job Title If Other, please specify.

Date of Incident Time of Incident Date Reported Time Reported

Reported to (Employee Name/Title) Classification of Incident Incident While Performing Shift Start Time

Was the employee on a ride break? Was the employee on a designated run? Was the employee working at the Were the employee's actions for the
time of the incident? purpose of work?

Location of Incident

Building Lift Run Road

Conditions (If applicable)

Run Type Density Weather Lighting Temperature Conditions Snow

Equipment & Ability (If applicable)

Equipment Binding Release Lessons Ability Helmet

Body Part Injured

Specific Description

Type of Injury
Specific Description

Incident Description

Describe what happened in detail including the sequence of events which preceeded the incident. Where appropriate use weights and measurements and reference
any additional images (e.g. photos, drawings, etc.)
Primary Cause (What action or failure to act directly caused the incident?)

Mechanical Factors Human Factors Management Factors Environmental Factors

Add Brief Description of Primary Causes

Additional Factors (What are the basic fundamental reasons for the existence of these acts and/or
conditions?) (Choose all that apply)

Mechanical Factors Human Factors Management Factors Environmental Factors

Add more information if necessary.

What remedial action has been or will be taken to prevent recurrence?

Completion Date Responsibility Approved By
Review incident details at management meeting

Communicate action items to associates

Other remedial actions that have or will be taken to prevent recurrence?

Completion Date Responsibility Approved By

Witness(es) Contact Info

1. Enter full name here Enter Contact Details
Enter witness statement

2. Enter full name here Enter Contact Details

Enter witness statement

First Aid Attendant First Aid Contact info

Form completed by:

List all the people that were involved in this investigation (including the Joint Occupational Health and Safety Committee (JOHSC) representative)

Include any additional comments or information here

version: Y12M05D11 Copyright © 2012 go2 Tourism HR Society

USER GUIDE

Initialization
1) ADD LOGO. On your first opening of the sheet you can add a custom logo of your choice. Click on "A
and corner of the sheet. The logo has a height of 60 pixels and a variable width. Should you want to re
JPEG(JPG), bitmap (BMP), or GIF fomats. You can save the template afterwards.

2) When you complete and capture your first report the sheet will automatically create a separate work
all reports you capture. It is located in the same directory as the "Incident Investigation report.xls" . M
moving the AllIncidents file will create multiple copies of the file and should be avoided.

3) There are a number of macroes in this workbook that are completely safe. Access to the file system i
may need to turn your macro security to low.
Fill in Information

1) When a new record is started the first field you should change is the employee's department. This w
common positions pertaining to that department. All the remaining positions are listed after the most c

2) Mandatory fields are coloured to help prompt you. Fill in each section with the pertinent informatio

Click to Choose
Some fields are only populated if you use the "Click to Choose" button and select options. This button
the selected options will be saved to the field.
Drop Down List
For fields with a limited number of valid options, drop down lists are connected to the cell. Click the arr

More Information and Examples

These buttons create pop ups that provide example s and more explanation of what is requested.

3) Remedial Action Section. This section is completed using 2 different controls. First select the "Click t
implemented to help avoid a recurrence. These selections will auto-fill rows. Each row will have a date
authorized the action. To fill in the date, select the cell corresponding to the date field for that row and
desired date. It's important that you select the cell you want filled in.

After Completion

There are 4 buttons on the sheet that aid in completing the process.
1) The save button can be used to save the sheet if you need more time or information to complete th
file in the same directory as the original template.
2) The print button will open the print dialog to select your preferred printer. Using this function will fo
overly long.
3) The E-Mail button should be used if you have Microsoft Outlook setup on your computer. You can ad
security warning will pop up. Select yes when the option becomes available. This will send a macro dis
Outlook isn't open then the messages will be saved in the outbox until Outlook is opened. If you don't
sheet to a PDF format and manually e-mail it.

4) The Capture Data button is the last step in the process. This will transfer all pertinent data to a centr
clear the sheet of data and you should select yes. Once you have captured data you should not captur
duplicates and skew historical information. If it's imperative to change data for an entry the "AllInciden
sheet to a PDF format and manually e-mail it.
4) The Capture Data button is the last step in the process. This will transfer all pertinent data to a centr
clear the sheet of data and you should select yes. Once you have captured data you should not captur
duplicates and skew historical information. If it's imperative to change data for an entry the "AllInciden
your choice. Click on "Add Logo" and the logo will be placed in the upper right
Should you want to remove the logo click "Delete Logo". Logo's must be in

y create a separate workbook named "AllIncidents.xls" that stores information on

tigation report.xls" . Moving this workbook from the current directory without
avoided.

cess to the file system is needed to create and modify files and because of this you

e's department. This will populate the Job Title drop down menu with the most
re listed after the most common.

the pertinent information. If a field doesn't apply put NA in it.

ct options. This button pops a menu up with checkboxes. When you press "Okay"

to the cell. Click the arrow button on the right side to view and select your value.

what is requested.

First select the "Click to Choose" and choose all future actions that will be
ch row will have a date for completion as well as who is assigned to and who
e field for that row and simply press the "Choose Date" button and select the

mation to complete the form. You can rename the report but you must save the

sing this function will format page breaks appropriately in case the form gets

r computer. You can add e-mail addresses to the pop up box and select OK. A
is will send a macro disabled copy of the sheet to the addresses selected. If
s opened. If you don't have Outlook installed it is recommended to print the

ertinent data to a central sheet called "AllIncidents.xls". This will also prompt to
you should not capture the same data to the database again as this will cause
an entry the "AllIncidents.xls" file can be modified.
ertinent data to a central sheet called "AllIncidents.xls". This will also prompt to
you should not capture the same data to the database again as this will cause
an entry the "AllIncidents.xls" file can be modified.
FAQ
1) I don't use Outlook, can I still e-mail the form?
Excel can only use Outlook and Microsoft Live Mail to send e-mails. If you don't use these then the best option i
and attach this file using the normal methods in your regular e-mail program.
2) I'm using Outlook but the e-mails aren't sending.
If Outlook is not actually running then the e-mails will be placed in the Outbox until you start the Outlook progr
security warning.

3) Can I move or save my Incident Investigation workbook under a different name?

You can rename and save the workbook for each incident but the directory you save the file in must remain the s
recommended you use the original file as a template and save copies of each incident if necessary.
4) What if I don't have the information when I start to fill out out the form?
Using the "Save" button, save the file under a unique name in the same folder as the template. The form can be
all the mandatory information. Once you have used the "capture" button the form should no longer be editted. S

5) What is the AllIncidents.xls file?

This file contains data for each incident you saved and is meant for gathering data to help you to identify and imp

6) Can I move or delete the AllIncidents file?

This file must remain in the folder where your reports are saved. If you move it or delete it, another one is creat

7) What happens when I capture data in the Incident Investigation report?

The data is saved in the AllIncidents file for future reference.
8) What if I accidentally capture the data twice?
Avoid this if possible but if it occurs either ignore the data when creating historical reports or you can modify the
information.

9) What if I captured the report but realized there was a mistake. Can I edit the AllIncidents file?
It is possible to modify the file. The sheet has been protected to avoid accidental data loss. Go to the "Review"
button. No password is needed. Modify your sheet and then hit the "Protect" button above.
10) How can I place a filter on the Sheet data?
Unprotect the sheet as above. Select all the data in the workbook . Go to the "Data" tab in the upper menu and sele
functions that will allow you to choose what to search for in each column.

11) What version of Excel is the form compatible with?

The form was developed for Excel 2003 and upward. Functionality can't be guaranteed for versions older than th

12) The form is having errors on opening!

Ensure your turn your macro security to low. To find out how to do this search "enabling EXCEL 2003 macros to
you are using into the year.
13) Why is the form printing strangely?
The form has a number of functions that change the length and format of the form and the native excel print function may
Form" button automatically reformats the page for printing on 8.5"x11" sheets and should be used to print the form.
e then the best option is to print the file as a PDF using the print button

start the Outlook program. Please ensure you select "Yes" to the

file in must remain the same. You can not move the workbook. It is
ecessary.

plate. The form can be updated as many times as necessary to collect

no longer be editted. See note 9 for details.

you to identify and improve areas or processes where incidents occur.

it, another one is created but you will lose all the previous report data.

s or you can modify the AllIncidents file. See below for more

ts file?
ss. Go to the "Review" tab in the upper menu and click the "Unprotect"
ve.

he upper menu and select filter. The first row will contain filter

or versions older than that.

EXCEL 2003 macros to run" in your web browser but sub the version

e excel print function may not interpret page breaks properly. The "Print
d to print the form.