Kevin Ian Schmidt

Accident Analysis Report – SAMPLE

sample accident analysis report - free downloadAn accident analysis report should be conducted for every accident, but also conducting an accident analysis for a near miss will create a safer workplace. It may seem excessive to treat every near miss as a full accident, but a near miss is just an accident where someone didn’t happen, this time.

A quality incident analysis consists of a root cause of every underlying factor, and corrective action for all identified.

I provide root cause training  on my blog here

This incident analysis report includes a root cause worksheet and instructions of use, so including it in your accident investigation packet serves as a constant reminder.

I have also published a book for Root Cause Analysis, available in softcover and hardcover. Check out my book on Amazon.

Reasons to Conduct an Accident Analysis for all Incidents:

  1. accident investigations are important even with a near missMore incidents and observations mean more data to analyze
  2. Incidents, observations, and investigations keep us aware
  3. Incident reporting is a key habit that creates culture
  4. Minor incidents and observations help to find out why serious incidents do not occur

The need for every near miss to be treated as an accident in the course of the investigation is based around the understanding that for every accident that results in an injury, there were 10 accidents in which no one was hurt, and for every one of those there were 10 near misses. So, that means that for every injury accident, there were 100 chances to address this issue, BEFORE someone was injured.

I have available all the necessary components of a comprehensive Incident Investigation Program.


This accident analysis report is a complete summary of your investigation, and is great for group review with an accident investigation committee or a workplace safety committee.

The four-point approach to accident analysis

You hope an accident doesn’t occur, but if one does, investigate and this systematic approach to analysis the investigation notes.

  • Collect data: Ideally, accidents should be investigated right away. Talk to witnesses as soon as possible. Take pictures and review maintenance and training records.
  • Identify the causes: By identifying the causes (there could be several), you can reduce the risk of a similar incident occurring. Accident investigation looks at four possible causes:
    • Equipment: Is it working properly? Are the guards and other safety precautions present and functioning?
    • At-risk behaviors: Were there safety procedures that weren’t implemented? Are safety procedures routinely enforced? Was the employee working alone?
    • Personnel: Was the employee properly trained for this particular job? Which shift was the employee working, and how long was the employee’s shift? Was the employee wearing personal protective equipment?
    • Environment: Was the work area properly lighted? Were work surfaces and the floor free of clutter? Was noise an issue? What about chemicals or dust? Was space sufficient to do the task? Was the workspace adjusted to the employee’s ergonomic needs?
  • Analyze the findings: Examine the facts and observations. Distinguish between immediate causes and underlying causes.
    • Examples of immediate causes: Unsafe conditions like a broken rung on a ladder or other mechanical failure, or an unsafe action by an employee such as running instead of walking.
    • Examples of underlying causes: Poor machine maintenance, a missing machine guard, a crowded work area or lack of training.
  • Develop a plan for corrective action: Here’s where you have a chance to learn from what’s happened and take steps to prevent it from happening again. Make recommendations to remedy each of the possible causes you identified. For example, you might suggest changes to machinery, work procedures, employee training, safety process or personnel.
Check Out: Simple Solutions to Reduce Workplace Accidents

A quality corrective action requires temporary measures, such as:

  • taking equipment out of service
  • training employees on safe operation of equipment
  • changing policies and/or procedures within the workplace
  • conducting an updated job hazard analysis

While also planning for permanent corrective actions such as:

  • implementing a preventative maintenance program
  • routine workplace inspections for deficiencies
  • training employees on hazard identification
  • creating a culture of workplace safety

Temporary corrective actions are ones that can be implemented anywhere from immediately after the incident up to 15 days, while a long term corrective action may take up years to fully roll-out and will require a commitment from the top of the organization.

View and Download the Sample Accident Analysis Form below


Sample Accident-Analysis Report

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