HEALTH & SAFETY
INCIDENT INVESTIGATION
A basic investigation can be conducted by one or two local relevant personnel. An ICAM (advanced) investigation must be conducted by a team of
personnel, where at least one member of the team has completed ICAM (advanced) training.
Incident investigator: This investigation form can be used to record results of the investigation prior to entering the details into ERMS. Investigation details
must be entered ERMS.
For use in conjunction with the Health & Safety: Incident, injury, hazard reporting and investigation requirements.
More help: http://safety.unimelb.edu.au/#incident-reporting or contact ohs-enquires@unimelb.edu.au
This information will be stored and used only in accordance with the university’s privacy policy: https://policy.unimelb.edu.au/MPF1104
All fields indicated with this symbol are mandatory. All other fields are completed where relevant.
Planning
Investigation Methodology (ICAM –also known as advanced - must be selected if the risk level is high or extreme)
Basic ICAM (advanced)
Details of the incident being investigated ERMS incident reference number
Name of person associated with incident: Date of Incident (dd/month/yyyy):
Description of incident:
Details of the incident investigation team
Names of persons in the investigation team Date of investigation (dd/month/yyyy):
Have any witnesses been interviewed as part of the incident investigation? (Complete only if witness(es) have been interviewed)
Name of witness(es) that have been interviewed:
Event timeline
Describe the sequence of events that led to the incident:
Describe the sequence of events following the incident:
Describe the task(s) being performed at the time of the incident:
Contributing Factors (Basic investigation only)
safety.unimelb.edu.au HEALTH & SAFETY: INCIDENT INVESTIGATION 1 of 4
Date: November 2019 Version: 1.1 Authorised by: Associate Director, Health & Safety Next Review: November 2024
© The University of Melbourne – Uncontrolled when printed.
Behavioural Causes
Fatigued Task design not appropriate
Procedure not appropriate Time pressure
Procedure not completed Training insufficient
Procedure not followed Unauthorised performance of task
Risk assessment not appropriate Unprofessional behaviour
Risk assessment not completed Working after hours
Stresses Working alone
Supervision not adequate Equipment not used correctly
Add additional information for each checked box:
Physical Causes
Equipment malfunctioning Safety equipment not used
Equipment not appropriate Weather
Flooring Workplace design not appropriate
Safety equipment malfunctioning Workplace poorly maintained
Safety equipment not appropriate Uncategorised cause
Add additional information for each checked box:
Contributing Factors (ICAM investigation only)
Environment
Hazardous substances Noise
Visibility Poor housekeeping
Inadequate ventilation Restricted access
Lighting Extreme temperatures
Loose, slippery or uneven surfaces
Add additional information for each checked box:
Equipment
Defective equipment Improper use of equipment and tools
Defective guards or protective devices Inadequate assembly or maintenance repair
Failing to use or overriding safety devices Inadequate ergonomic design
Improper placement of tools, equipment or material Inadequate or defective safety devices
Add additional information for each checked box:
Organisation
Improper waste disposal Inadequate pre-task checking
Inadequate audit/inspection/monitoring No or inadequate job safety analysis
Inadequate supervision Use of non-approved or not inducted contractor
Inadequate work planning
Add additional information for each checked box:
People
Alcohol & Drugs Manual handling
Fatigue Misunderstanding of instructions
Failure to follow a Safe Work Procedure Non-compliance or unauthorized working
Inadequate communication between persons involved Risk taking
Inappropriate behavior Stress
Lack of or inadequate training
Add additional information for each checked box:
Procedures
Inadequate health and safety information Operating procedures outdated
None or inadequate Procedures/ Standards/ Guidelines
Add additional information for each checked box:
Analysis (ICAM investigation only)
Absent or Failed Defenses
Awareness – communication Detection – vigilance/fatigue
Awareness – competence/knowledge Detection – visual warning systems
safety.unimelb.edu.au HEALTH & SAFETY: INCIDENT INVESTIGATION 2 of 4
Date: November 2019 Version: 1.1 Authorised by: Associate Director, Health & Safety Next Review: November 2024
© The University of Melbourne – Uncontrolled when printed.
Awareness – hazard identification Escape and rescue – emergency communication
Awareness – supervision Escape and rescue – emergency planning response
Awareness – work instruction/procedures Escape and rescue – safe access/egress
Control and recovery – bypass valves/circuits Protection and containment – bunding/barricading/exclusion zones
Control and recovery – emergency shutdown Protection and containment – fire fighting
Control and recovery – procedures Protection and containment – PPE
Detection – aural warning systems Protection and containment – spill response
Detection – gas/substance Other
Detection – speed/movement detectors
Add additional information for each checked box:
Individual/Team Actions
Change management error Operating authority error or violation
Equipment use error or violation Operating speed
Equipment/materials handling error or violation PPE use error or violation
Hazard management error or violation Procedural compliance
Hazard recognition/perception Supervisory error or violation
Horseplay/thrill seeking error or violation Work method error or violation
Occupational hygiene practices Other
Add additional information for each checked box:
Organisational
Change management error Operating authority error or violation
Equipment use error or violation Operating speed
Equipment/materials handling error or violation PPE use error or violation
Hazard management error or violation Procedural compliance
Hazard recognition/perception Supervisory error or violation
Horseplay/thrill seeking error or violation Work method error or violation
Occupational hygiene practices Other
Add additional information for each checked box:
Task/Environmental Conditions – Human Factors
Drugs/alcohol influence Peer pressure/supervisory example
Fatigue Perceived licence to bend rules
Poor communications Personal issues
Behavioural beliefs Personality/attitude
Change of routine Physical capabilities
Competency Physical capabilities
Complacency/motivation/desensitization to hazard Physical stress
Confidence levels Poor shift patterns and overtime working
Distraction/preoccupation Reliance of undocumented knowledge
Experience/knowledge/skills for task Secondary goals
Mental capabilities Situation awareness
Mental stress Time/productivity pressures
Passive tolerance of violations Other human factor
Add additional information for each checked box:
safety.unimelb.edu.au HEALTH & SAFETY: INCIDENT INVESTIGATION 3 of 4
Date: November 2019 Version: 1.1 Authorised by: Associate Director, Health & Safety Next Review: November 2024
© The University of Melbourne – Uncontrolled when printed.
Task/Environmental Conditions – Workplace Factors
Abnormal operational situation/condition Radiation
Chemicals Reduced/restricted visibility
Congestion/restriction/access Routine/non-routine task
Equipment integrity Surface gradient/conditions
Equipment/material temperature/conditions Task planning/preparation/manning
Fire and/or explosion hazard Tools/equipment condition/availability
Gas, dust or fumes Ventilation
Hazard analysis/job safety analysis Weather conditions
Housekeeping Wildlife
Lighting Work procedures availability and suitability
Materials availability and suitability Other workplace factor
Noise
Add additional information for each checked box:
Conclusion (ICAM investigation)
Conclusions
Recommendations
Learnings
safety.unimelb.edu.au HEALTH & SAFETY: INCIDENT INVESTIGATION 4 of 4
Date: November 2019 Version: 1.1 Authorised by: Associate Director, Health & Safety Next Review: November 2024
© The University of Melbourne – Uncontrolled when printed.
