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Incident Investigation Form
"I need an Incident Investigation Form for our chemical manufacturing plant in Jakarta that includes detailed sections for hazardous material exposure and environmental impact assessment, with specific reference to Indonesian chemical industry safety regulations and BPJS reporting requirements."
1. Incident Basic Information: Date, time, location, and type of incident
2. Affected Person(s) Details: Information about individuals involved including employees, contractors, or visitors
3. Incident Description: Detailed narrative of what occurred, including sequence of events
4. Immediate Actions Taken: Emergency response measures and immediate steps taken after the incident
5. Witness Information: Details of witnesses and their initial statements
6. Investigation Findings: Root cause analysis and contributing factors identified
7. Environmental Conditions: Workplace conditions, weather, lighting, etc. at time of incident
8. Equipment/Materials Involved: Details of any equipment, tools, or materials involved in the incident
9. Corrective Actions: Recommended and implemented measures to prevent recurrence
10. Sign-off Section: Signatures of investigator, supervisor, and safety officer
1. Medical Assessment: Details of medical evaluation and treatment, used when injury occurs
2. Property Damage Assessment: Evaluation of damage to equipment or facilities, used when property is affected
3. Environmental Impact: Assessment of environmental effects, used for incidents involving spills or emissions
4. Production Impact: Analysis of impact on operations and production, used for major incidents
5. Third Party Involvement: Details of external parties involved, used when contractors or visitors are affected
6. Legal Compliance Review: Assessment of regulatory compliance issues, used for serious incidents
1. Photographic Evidence: Photos of incident scene, damage, or relevant conditions
2. Witness Statements: Detailed written accounts from witnesses
3. Medical Reports: Copies of medical assessments and treatment records
4. Equipment Inspection Reports: Technical evaluations of involved equipment
5. Site Diagrams: Sketches or plans showing incident location and relevant details
6. Training Records: Documentation of relevant training for involved personnel
7. Risk Assessment Forms: Pre-existing risk assessments related to the activity
8. Maintenance Records: Equipment maintenance history if relevant to the incident
Authors
Manufacturing
Construction
Mining
Oil and Gas
Transportation
Logistics
Healthcare
Agriculture
Chemical Processing
Retail
Hospitality
Food Production
Automotive
Telecommunications
Utilities
Pharmaceutical
Warehousing
Education
Maritime
Aviation
Health and Safety
Human Resources
Operations
Quality Assurance
Risk Management
Facilities Management
Security
Emergency Response
Environmental Health
Production
Maintenance
Training
Compliance
Medical Services
Health and Safety Manager
Safety Officer
Department Supervisor
Plant Manager
HR Manager
Risk Management Officer
Operations Manager
Facility Manager
Site Supervisor
Quality Control Manager
Production Supervisor
Maintenance Manager
Environmental Health Officer
Compliance Officer
Security Manager
Line Supervisor
Training Coordinator
Emergency Response Coordinator
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