Investigation Review Questionnaire

A review of your Accident investigation should be conducted three months after its completion to ensure the investigation is complete and the Corrective Action Plan has been finalized. Consider the following questions:

1. Were the accident report forms completed at the time of the accident?
2. Were the accident "compensation" report forms completed at the time of the accident?
3. Was the CEO/GM advised of the accident when it was first reported?
4. Was the health and safety representative advised of the accident when it was first reported?
5. Has a documented investigation been initiated?
6. Has the investigation been completed?
7. Who conducted the investigation?
   1. Name:______________________________________________
8. Who was responsible for the investigation?
   1. Name:_______________________________________________
9. Did the investigation assess the organizations legal (non compliances) exposures?
10. How long did the investigation take to complete from the date of the accident?
    1. ( _________days) ( _________hours)
11. Was a Corrective Action Plan (CAP) developed from the investigation findings?
12. Was the Corrective Action Plan (CAP) in writing?
13. Did the Corrective Action Plan (CAP):
    1. Assign responsibilities to the actions required?
    2. Consider time parameters for completion of the actions required?
    3. Allocate and approve resources to develop and complete the actions required?
14. Was the Corrective Action Plan (CAP) approved by management?
15. Has the Corrective Action Plan (CAP) been completed as proposed?
16. Have any modifications been made to the approved Corrective Action Plan (CAP)?
17. Has the Corrective Action Plan (CAP) been assessed to ensure it is suitable as first planned?
18. Has the Corrective Action Plan (CAP) been:
    1. Signed off by Senior Management if completed?
    2. Dated to show when it was completed?
19. Did the Corrective Action Plan (CAP) fully address the accidents corrective actions required?
20. Did the Corrective Action Plan (CAP) ensure we now comply legally with our responsibilities?
21. Was the completed accident investigation form reviewed and signed off by the GM/CEO?
22. Who was the accident investigation completed form circulated to:
    1. Involved personnel?
    2. Health & safety representative(s)?
    3. Health & safety committee?
    4. Team leader/front line manager?
    5. GM/CEO?
23. List the actions still required to complete the investigation and the corrective action plan.
24. Is a further review required of this incident?  When: ________ Date: _________

Source: Gavin Johnson, Consultant NSCA (National Safety Council Australia)

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