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Incident/Near miss investigation form - template 

The reason for investigating an incident or near miss is to determine: the cause or causes of the incident; to identify any risks, hazards, systems or procedures that contributed to the incident; and to recommend corrective action to prevent similar incidents.

Incidents should be investigated by people knowledgeable about the type of work involved at the time of the incident. HSRs or relevant workers should also be involved in the investigation.

An incident /near miss investigation report should answer the WHO, WHERE, WHEN, WHAT, WHY and HOW questions with regard to an incident.

Note: this template is for internal use only, and should not be submitted to WorkCover NSW
Catalogue Number:
WC03590