Appendix A
ACCIDENT INVESTIGATION TEAM REPORT TEMPLATE

Report Title

Report Date

           Incident Location:

                  Incident Date:

Organizations Involved:

Investigating Team

                 Team Leader:

             Team Members:

 

 

 

Appointing Official:

Report Contents

1. Executive Summary

A brief summary, preferably less than one page.

2. Facts

A description of all of the facts leading up to the accident or incident. Usually a chronological narrative works best, but any logical arrangement of the facts that tells the story is acceptable. Avoid drawing any conclusions in this section of the report.

3. Analysis

Describe the analytical tools that were used and the results of scientific analysis and expert opinions collected. Include a summary version of a Time-Ordered-Events Chart if available.

4. Conclusion

Explain the team's conclusions concerning root causes and contributing factors, linking conclusions to the facts and results of analyses performed.

5. Judgment of Needs

Identify those areas that the team believes require attention to preclude a recurrence, and to prevent other unwanted events. Leave development of detailed recommendations and implementation plans to the appropriate line management organization.

6. Signature Page

All team members must sign the report. Team members who disagree with portions of the report must identify their areas of disagreement and should be encouraged to submit minority reports.

7. Minority Reports