Complete Incident Investigation

To complete an Incident Investigation Form, select the Edit Incident Investigation Icon to the right of the Incident Investigation you want to edit.

This will open the Add/Edit Incident Investigation window. Update any fields (if needed), answer the questions in the Incident Description section, list any affected employees in the Affected Employees section, and select theSave Button .

Incident Investigation Fields Breakdown
Overview Fields	Description
ID (Leave blank for automatic)	Manually enter an ID or one will be automatically generated
Release Incident Title	Incident Investigation Title
Date of Release Incident	Date of the release
NAICS Code	The NAICS Code
Chemical Released	The name of the chemical released
Type of Release	The type of release
Quantity Released (lbs.)	The amount released (in lbs.)
Reported*	Check the box if the Incident was reported to any Agencies
Agency Reported To *(if Reported field is checked)	The Agency Reported to
Case #*(if Reported field is checked)	The Case # given when reported to an Agency
Injuries or Property Damage	List any injuries and/or property damage
Date Investigation Began	The date the Investigation began
Incident Investigation Team Membership with Company Title & Function	Members of the Incident Investigation Team, with their company title and function
Date of Report	The date of the report
1. Incident Description Fields	Description
1.1 Location, Rate, Time and Duration Please include specific descriptions of impacts on and or offsite affected by the Incident, when the Incident was first detected or reported, and how long it lasted.	Record the requested information
1.2 Circumstances Leading up to Incident Briefly describe the operating conditions just prior to the Incident including loads, pressures, weather, equipment status, etc. Note who was in charge and whether or not there were any abnormal circumstances or early indications of a problem.	Record the requested information
1.3 Events and Actions as Incident Unfolded Provide a chronology of events including who discovered the Incident, how it was reported, how it was responded to, and how and when it was brought under control.	Record the requested information
1.4 Assessment of Root Cause Outline the Team's consensus view of the underlying cause of the Incident. If there are multiple hypotheses that cannot be ruled out, they should also be included. This should be the condition or event which started the sequence of events which resulted in the near-miss or actual Incident.	Record the requested information
1.5 Assessment of Additional Contributing Causes List conditions, actions, or events which contributed to the seriousness of the Incident or which should have, but did not, mitigate the effects of the root cause. Comment specifically on the following preventive elements of the PSM standard.	Record the requested information
Was the design of the system, including materials of construction, adequate?	Choose Yes or No. If no is selected, please give a description
Was the management system in place adequate and functioning effectively to prevent an unintentional release?	Choose Yes or No. If no is selected, please give a description
Did the Process Hazard Analysis adequately address the root causes of the release Incident?	Choose Yes or No. If no is selected, please give a description
Were the Standard Operating Procedures properly prepared and were they being followed when the release Incident occurred?	Choose Yes or No. If no is selected, please give a description
Was the training received by the operators involved adequate with current records in place to verify that training had been received and understood?	Choose Yes or No. If no is selected, please give a description
Was a preventive maintenance program deficiency a contributing factor in this release?	Choose Yes or No. If no is selected, please give a description
Was a pre_startup review deficiency a contributing factor in this release?	Choose Yes or No. If no is selected, please give a description
Was a management of change deficiency a contributing factor in this release?	Choose Yes or No. If no is selected, please give a description
Was the emergency response staffing, procedures, and/or training a contributing factor to injuries or property loss in this release?	Choose Yes or No. If no is selected, please give a description
1.6 Actions or Circumstances Which Helped Outline any administrative, operating, process or engineering controls which tended to mitigate the effects of the Incident. Particularly in the case of a near-miss, this would explain why the Incident was controlled. Also include things that might have been done to minimize the effects of the Incident.	Record the requested information
2. Affected Employees Field	Description
List by name or job descriptions, all employees or contractors, whose work assignments were or could have been affected by the release Incident.	Record the requested information