The ICAM investigation template.
A printable template for a thorough investigation, from the first 60 minutes to sign-off. Print it and fill it in by hand; to fill one in on screen, use the incident report template.
Initial response
The first 60 minutes.
- Make the scene safe for investigators
- Confirm injured people are receiving care
- Secure the scene with barriers and signs
- Identify and preserve evidence
- Identify witnesses
- Start documenting: photographs and notes
- Notify the people who must be told: management and regulators
Evidence preservation log
| Evidence | Location | Preserved by | Date and time |
|---|---|---|---|
| Physical evidence | |||
| Documents and records | |||
| Electronic data | |||
| Photographs | |||
| Video |
Witnesses
| Name | Role | Contact | Priority |
|---|---|---|---|
| HighMediumLow | |||
| HighMediumLow | |||
| HighMediumLow |
Incident description
| Field | Details |
|---|---|
| Date | |
| Time | |
| Location | |
| Area or department | |
| Type of incident | |
| Severity | FatalityLost timeMedical treatmentFirst aidNear missProperty |
PEEPO analysis
Evidence for each element, and whether it contributed.
People
Training, competence, experience, fitness, fatigue, supervision, communication.
| Factor | Present? | Details and evidence |
|---|---|---|
| Adequate training for the task | YesNoNot known | |
| Competency verified | YesNoNot known | |
| Enough experience | YesNoNot known | |
| Fit for duty | YesNoNot known | |
| Rested, not fatigued | YesNoNot known | |
| Adequate supervision | YesNoNot known | |
| Clear communication | YesNoNot known |
Environment
Weather, lighting, noise, temperature, housekeeping, layout.
| Factor | Condition | Contributed? | Details |
|---|---|---|---|
| Weather | YesNoMaybe | ||
| Lighting | YesNoMaybe | ||
| Noise | YesNoMaybe | ||
| Housekeeping | YesNoMaybe | ||
| Workspace layout | YesNoMaybe | ||
| Ground conditions | YesNoMaybe |
Equipment
Design, condition, maintenance, guarding, PPE, tools.
| Factor | Condition | Contributed? | Details |
|---|---|---|---|
| Fit for purpose | YesNoMaybe | ||
| Maintenance current | YesNoMaybe | ||
| Pre-use inspection done | YesNoMaybe | ||
| Guards and safety devices working | YesNoMaybe | ||
| Correct PPE available and worn | YesNoMaybe |
Procedures
Existence, quality, access, clarity, use, permits and risk assessments.
| Factor | Condition | Contributed? | Details |
|---|---|---|---|
| Procedure exists for the task | YesNoMaybe | ||
| Procedure followed | YesNoMaybe | ||
| Risk assessment current | YesNoMaybe | ||
| Permit obtained where required | YesNoMaybe | ||
| Job safety analysis completed | YesNoMaybe |
Organisation
Culture, management systems, resources, priorities, change management.
| Factor | Condition | Contributed? | Details |
|---|---|---|---|
| Staffing levels | YesNoMaybe | ||
| Resources | YesNoMaybe | ||
| Production pressure | YesNoMaybe | ||
| Safety culture | YesNoMaybe | ||
| Management of change | YesNoMaybe |
Cause analysis: 5 Whys
One chain per contributing factor.
Chain 1
| Level | Question | Answer |
|---|---|---|
| Why 1 | Why did this happen? | |
| Why 2 | Why? | |
| Why 3 | Why? | |
| Why 4 | Why? | |
| Why 5 | Why? |
Chain 2
| Level | Question | Answer |
|---|---|---|
| Why 1 | Why did this happen? | |
| Why 2 | Why? | |
| Why 3 | Why? | |
| Why 4 | Why? | |
| Why 5 | Why? |
Corrective actions
On the hierarchy of controls: elimination first, PPE last.
| No. | Cause | Action | Control level | Owner | Due | Done |
|---|---|---|---|---|---|---|
| 1 | ||||||
| 2 | ||||||
| 3 | ||||||
| 4 | ||||||
| 5 |
Summary and sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Lead investigator | |||
| Area manager | |||
| Safety manager |
Free from InvestigatePro, investigatepro.app. Written by Devon Turner, 15+ years in mining safety.
Let the method guide every investigator.
InvestigatePro walks each investigator through ICAM with a coach, so the structure in this template is applied the same way on every case.