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Incident Investigation Form

Incident Investigation Form Template for Philippines

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Key Requirements PROMPT example:

Incident Investigation Form

"I need an Incident Investigation Form for our manufacturing facility in Manila that includes bilingual sections in English and Tagalog, with specific focus on machinery accidents and chemical spills, compliant with latest DOLE regulations effective January 2025."

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Document background
The Incident Investigation Form is a crucial document required under Philippine workplace safety regulations, specifically designed to comply with Republic Act No. 11058 and DOLE Department Order No. 198-18. This form is essential for documenting and investigating workplace incidents, accidents, and near-misses in a systematic and thorough manner. It must be completed whenever an incident occurs that affects employee safety, property damage, or operational disruption. The document includes detailed sections for incident description, witness statements, root cause analysis, and corrective actions, serving as both an immediate response tool and a record for future reference and regulatory compliance. It helps organizations maintain proper documentation for insurance claims, workers' compensation, and government reporting while supporting continuous improvement in workplace safety practices.
Suggested Sections

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

2. Reporter Information: Details of the person reporting the incident, including name, position, and contact information

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

4. Affected Persons: Information about all persons involved in or affected by the incident, including employees, contractors, or visitors

5. Witness Information: Details of witnesses, including names, contact information, and initial statements

6. Environmental Conditions: Description of workplace conditions at the time of incident (lighting, weather, equipment status, etc.)

7. Root Cause Analysis: Investigation findings on direct and underlying causes of the incident

8. Immediate Actions Taken: Description of immediate response actions and emergency measures implemented

9. Corrective Actions: Detailed preventive and corrective measures to be implemented to prevent recurrence

10. Investigation Team: Names and roles of personnel conducting the investigation

Optional Sections

1. Medical Report Section: Detailed medical information and treatment details when incident results in injury

2. Property Damage Assessment: Detailed evaluation of damage to equipment, facilities, or materials when applicable

3. Environmental Impact: Assessment of environmental effects for incidents involving spills, emissions, or other environmental concerns

4. Third Party Involvement: Additional section for incidents involving external parties or contractors

5. Cost Impact Analysis: Financial assessment of incident impact when significant costs are involved

6. Legal Compliance Review: Additional section for incidents requiring specific regulatory reporting or legal review

Suggested Schedules

1. Appendix A - Photographic Evidence: Photographs, diagrams, or sketches of the incident scene and relevant details

2. Appendix B - Witness Statements: Detailed written statements from witnesses

3. Appendix C - Related Documents: Relevant documentation such as maintenance records, training records, or procedures

4. Appendix D - Risk Assessment: Pre-incident risk assessments and post-incident risk evaluation

5. Appendix E - Medical Reports: Copies of medical certificates or reports if applicable

6. Appendix F - Investigation Timeline: Detailed timeline of events before, during, and after the incident

7. Appendix G - Action Tracking Sheet: Template for tracking implementation of corrective actions

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

Linkedin in social icon imageX social icon image
alex.den.21@genieai.co
Relevant legal definitions
Incident
Accident
Near Miss
Hazard
Root Cause
Contributing Factor
Affected Person
Witness
Investigation Team
Corrective Action
Preventive Action
Safety Officer
First Aid Treatment
Lost Time Incident
Personal Protective Equipment (PPE)
Work Area
Authorized Person
Emergency Response
Medical Treatment Case
Risk Assessment
Immediate Cause
Underlying Cause
Property Damage
Safety Violation
Recordable Incident
Dangerous Occurrence
Control Measures
Critical Equipment
Workplace
Direct Supervisor
Investigation Report
Material Evidence
Occupational Disease
Safety Protocol
Work-Related Injury
Relevant Industries

Manufacturing

Construction

Mining

Healthcare

Transportation

Logistics

Agriculture

Food Processing

Chemical Industry

Retail

Hospitality

Education

Energy

Telecommunications

Maritime

Aviation

Relevant Teams

Health and Safety

Human Resources

Operations

Quality Assurance

Risk Management

Compliance

Security

Facilities Management

Production

Maintenance

Environmental Health

Legal

Emergency Response

Occupational Health

Relevant Roles

Safety Officer

Health and Safety Manager

Facility Manager

Operations Manager

Human Resources Manager

Risk Manager

Department Supervisor

Quality Assurance Manager

Compliance Officer

Security Manager

Plant Manager

Site Supervisor

Environmental Health Officer

Occupational Health Nurse

Production Manager

Maintenance Manager

Industries
Republic Act No. 11058: An Act Strengthening Compliance with Occupational Safety and Health Standards (OSHS) - This law mandates proper documentation and investigation of workplace incidents and accidents, including requirements for reporting and prevention measures.
DOLE Department Order No. 198-18: Implementing Rules and Regulations of Republic Act No. 11058 - Provides specific guidelines for incident investigation procedures, reporting requirements, and documentation standards.
Republic Act No. 10173: Data Privacy Act of 2012 - Ensures the protection of personal information in incident reports and investigations, including medical information and personal details of involved parties.
Presidential Decree No. 442: Labor Code of the Philippines - Provides fundamental guidelines on employer responsibilities regarding workplace safety and incident reporting.
DOLE Department Order No. 136-14: Guidelines for the Implementation of Mandatory Workers' Coverage in the Employees' Compensation Program - Relevant for documenting incidents that may lead to workers' compensation claims.
Republic Act No. 8282: Social Security Act - Important for documentation of incidents that may result in SSS claims and benefits.
DOLE-BWC Technical Notes on Work Accident Investigation: Technical guidelines providing standard procedures and methodologies for conducting workplace accident investigations and documentation requirements.
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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