Investigating an Incident

• Incident Reporting System User Guide (Investigation)

This section requires local incident investigations to confirm the safety measures or arrangements in place prior to the incident. Details provided in this section will generally be derived from measures included in the Standard Operating Procedures (SOP’s) or relevant Risk Assessments produced by the Faculty/Department, which should be readily available to members of staff. This field is for free text, therefore reporting individuals should click in the designated box and manually enter any relevant additional details available.

This section requires local incident investigations to confirm actions taken immediately following the incident to prevent further harm. Details provided in this section will generally include details of initial responses and actions following an incident, and may include but may not be limited to actions such as the shutdown or postponement of works, the reporting of a fault, restriction on access, and contacting of emergency services. This section is for information relating to short term solutions intended to prevent immediate recurrences or additional harm. This field is for free text, therefore reporting individuals should click in the designated box and manually enter any relevant additional details available.

This section requires local incident investigations to provide a summary of actions taken following the incident to prevent future long-term recurrences. Details provided in this section will generally include details of responses to the primary findings of the internal incident investigation, and may include but may not be limited to actions such as amendments or changes to Standard Operating Procedures, revisions to existing risk assessments, and the identification of additional training requirements. This field is for free text, therefore reporting individuals should click in the designated box and manually enter any relevant additional details available.

This section requires local incident investigations to confirm the immediate or basic causes of the incident or near miss, as identified by the incident investigation. This may or may not be similar to the type of incident identified by the reporting individual in the Incident Report Form. This will be associated with the agent of injury or ill health.

This section requires local incident investigations to confirm the root or underlying causes of the incident or near miss, as identified by the incident investigation. The underlying causes will generally involve or result from unsafe acts and/or unsafety conditions e.g. guarding removed, ventilation switched off, etc.

This section requires local incident investigations to confirm the root causes of the incident or near miss, as identified by the incident investigation. This will be the failure from which all other failings grow, often remote in time and space from the adverse event (e.g. failure to identify training needs and assess competence, low priority given to risk assessment etc.). The root causes of adverse events are almost inevitably management, organisational or planning failures.

This section requires local incident investigations to confirm whether the relevant risk assessment(s) related to an activity have been reviewed following the incident investigation. It would be considered good practice to review all associated risk assessments following an incident or near miss. The review may include modifying existing or identifying additional control measures in order to prevent reoccurrence and address the root, underlying or immediate causes. This review should be documented even when no actual amendments have been made to the risk assessment(s).