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Investigation DetailsInvestigation DetailsInvestigation DetailsInvestigation DetailsCause Analysis

Section	Question	Explanation
Notifiable Event	Is this a notifiable event?	A notifiable event is any incident of a particular severity that is required to be notified to the respective state regulatory body. In NSW, it is SafeWork NSW. Serious injury, illness, dangerous incident or death must be notified. If you are unsure about whether the incident is notifiable, select UNSURE and answer the questions that appear. If the incident is notifiable, contact the WHS Coordinator or HR immediately.
Investigation Details	What is to be investigated?
	Investigation Details	Did this accident generate an injury?	Injury category
	Date of investigation
	Investigation Details	Agency of event
	Mechanism of event
	Supporting images (if applicable)
	Investigation Details	Was this person trained in the task?
	Investigation Details	How long was the person working for in this shift before the event happened?
	Investigation Details	Period of employment/study of person involved:
	Lost time (in hours):
	Investigation Details	Did this injury result in an insurance claim?	Did this injury result in an insurance claim? Claim reference number
Cause Analysis	Absent/failed defences factors
	Cause Analysis	Individual/team factors
	Cause Analysis	Task/environmental factors
	Organizational factors
Investigation Outcome	Investigation outcome statement
Resulting Actions	Corrective Actions (if required)

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