Incident Investigation Form Template for Belgium

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Key Requirements PROMPT example:

Incident Investigation Form

"I need an Incident Investigation Form for our chemical manufacturing facility in Belgium that emphasizes hazardous material handling and includes detailed environmental impact assessment sections, while ensuring compliance with both GDPR and industry-specific safety regulations."

Document background
The Incident Investigation Form is a crucial document required under Belgian workplace safety legislation for investigating and documenting workplace incidents, accidents, and near-misses. It is designed to comply with the Act of 4 August 1996 on Well-being of Workers and subsequent Royal Decrees governing workplace safety and incident reporting. The form should be used whenever a workplace incident occurs, ranging from minor accidents to serious injuries or near-misses, and must be completed within the legally prescribed timeframes. It captures essential information about the incident, involved parties, witness statements, root cause analysis, and corrective actions while ensuring compliance with GDPR requirements for personal data handling. The document serves multiple purposes: legal compliance, insurance documentation, prevention of future incidents, and demonstration of due diligence in workplace safety management.
Suggested Sections

1. Incident Basic Information: Essential details including date, time, location, and type of incident

2. Affected Persons: Information about injured/affected individuals, including workers, contractors, or visitors (with GDPR compliance notices)

3. Incident Description: Detailed narrative of what occurred, including immediate circumstances and sequence of events

4. Immediate Actions Taken: Emergency responses and immediate measures taken following the incident

5. Witness Information: Details of witnesses and their initial statements (with GDPR compliance notices)

6. Investigation Findings: Analysis of root causes, contributing factors, and investigation methodology

7. Risk Assessment: Evaluation of existing risk assessments and identification of new risks

8. Corrective Actions: Detailed preventive and corrective measures to be implemented

9. Reporting Requirements: Checklist of necessary notifications to authorities, insurers, and internal stakeholders

Optional Sections

1. Environmental Impact: Assessment of environmental consequences, required when incident involves environmental hazards or spillages

2. Equipment/Property Damage: Detailed assessment of material damage, required when incident involves equipment or property damage

3. Third Party Involvement: Information about involved external parties, required when contractors or public are involved

4. Production Impact Assessment: Analysis of impact on operations and production, required for incidents affecting business operations

5. Medical Report Section: Detailed medical information and assessment, required for incidents involving injuries

Suggested Schedules

1. Photographic Evidence: Photographs, diagrams, or sketches of the incident scene and relevant evidence

2. Witness Statement Forms: Standardized forms for collecting detailed witness accounts

3. Risk Assessment Matrix: Template for evaluating severity and likelihood of similar incidents

4. Incident Classification Guide: Reference guide for categorizing type and severity of incidents

5. Regulatory Reporting Checklist: Checklist of required notifications based on incident type and severity

6. Action Plan Template: Format for documenting and tracking corrective actions

7. Investigation Method Guidelines: Reference guide for investigation techniques and procedures

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions
Relevant Industries

Manufacturing

Construction

Healthcare

Logistics and Transportation

Mining and Raw Materials

Chemical Industry

Food Processing

Retail

Education

Hospitality

Energy and Utilities

Agriculture

Pharmaceutical

Automotive

Waste Management

Relevant Teams

Health and Safety

Operations

Human Resources

Quality Assurance

Facilities Management

Risk Management

Compliance

Production

Environmental Health

Occupational Health

Legal

Training and Development

Relevant Roles

Health and Safety Manager

Prevention Advisor

Operations Manager

Department Supervisor

Human Resources Director

Quality Assurance Manager

Facility Manager

Risk Manager

Compliance Officer

Line Manager

Production Supervisor

Environmental Health Officer

Occupational Health Nurse

Safety Engineer

Training Coordinator

Industries
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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