Incident Investigation Report Form - FREE PDF
Investigate workplace incidents for prevention.
- Industry: Manufacturing
- Frequency: Each incident
- Estimated Time: 1-4 hours
- Role: Safety / Supervisor / Manager
- Total Items: 32
- Compliance: OSHA, ISO 45001:2018 Clause 10.2
Compliance Verification
Verify OSHA requirements.
- Procedures followed correctly?
- Records complete and accurate?
- Standards/specifications met?
Equipment/Process Condition
Assess equipment or process status.
- Equipment operating properly?
- Maintenance current?
- Calibration/verification current?
Safety & Environment
Verify safety and environmental controls.
- Safety guards/devices in place?
- Required PPE used correctly?
- Housekeeping acceptable?
Findings & Actions
Document findings and required actions.
- Overall Result
- Findings
- Corrective Actions
- Follow-up Date
- Auditor Signature
Pre-Shift Verification & Setup
Initial verification before operations begin
- Operator / Inspector Name
- Date
- Shift Number
- Production Line / Area
- Previous shift handover notes reviewed?
Safety Protocols & Compliance
Verify all safety measures are in place per OSHA standards
- LOTO procedures verified for all equipment?
- All machine guards in place and secured?
- Emergency stop buttons tested and functional?
- Required PPE worn by all operators?
- Safety signage visible and current?
Equipment & Operational Readiness
Verify equipment is calibrated and operational
- Equipment calibration current and documented?
- All gauges and instruments reading correctly?
- Lubrication schedule maintained?
- Any abnormal sounds, vibrations, or leaks?
Quality Control Standards
Verify product quality meets specifications
- Current specifications/work instructions available?
- First article inspection completed?
- Measurement tools calibrated and in tolerance?
- Reject/scrap rate within acceptable limits?
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Why Use This Incident Investigation Report Form?
This incident investigation report form helps manufacturing teams maintain compliance and operational excellence. Designed for safety / supervisor / manager professionals, this checklist covers 32 critical inspection points across 8 sections. Recommended frequency: each incident.
Ensures compliance with OSHA, ISO 45001:2018 Clause 10.2. Regulatory-aligned for audit readiness and inspection documentation.
Frequently Asked Questions
What does the Incident Investigation Report Form cover?
This checklist covers 32 inspection items across 8 sections: Compliance Verification, Equipment/Process Condition, Safety & Environment, Findings & Actions, Pre-Shift Verification & Setup, Safety Protocols & Compliance, Equipment & Operational Readiness, Quality Control Standards. It is designed for manufacturing operations and compliance.
How often should this checklist be completed?
This checklist should be completed each incident. Each completion takes approximately 1-4 hours.
Who should use this Incident Investigation Report Form?
This checklist is designed for Safety / Supervisor / Manager professionals in the manufacturing industry. It can be used for self-assessments, team audits, and regulatory compliance documentation.
Can I download this checklist as a PDF?
Yes, this checklist is available as a free PDF download. You can also use it digitally in the POPProbe mobile app for real-time data capture, photo documentation, and automatic reporting.