Free incident investigation and root cause analysis form
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Free incident investigation and root cause analysis form (PDF-ready). Covers 5 Whys, timeline, witness statements and corrective actions. Download free.
Commercial Director
Updated 3 May 2026
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What is a incident investigation and root cause analysis form?
An incident investigation is a systematic process of examining a workplace incident (injury, illness, near miss, property damage or environmental event) to determine why it happened and what can be done to prevent recurrence. Where an incident report records what happened, the investigation goes deeper, examining contributing factors, root causes and organisational failures using structured analysis techniques such as the 5 Whys, ICAM (Incident Cause Analysis Method) and fishbone (Ishikawa) diagrams. A thorough investigation produces corrective actions with assigned owners and due dates, and a follow-up verification process to confirm effectiveness.
The purpose of an incident investigation is not to assign blame but to understand the systemic factors that allowed the incident to occur. By identifying root causes at the organisational level, such as inadequate procedures, insufficient training, poor design or conflicting priorities, the investigation drives systemic improvements that prevent similar incidents across the entire operation. Under Australian WHS legislation, PCBUs have a duty to investigate incidents and implement corrective actions as part of their risk management obligations. The WHS Act Part 3 also requires that notifiable incidents (death, serious injury or illness, and dangerous incidents) are reported to the regulator immediately, and the incident scene must be preserved until an inspector directs otherwise. A structured investigation form ensures these regulatory requirements are met consistently and that the organisation retains a defensible record of its response.
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Benefits of using this incident investigation and root cause analysis form
- Root cause identification: structured analysis techniques (5 Whys, ICAM, fishbone) prevent investigations from stopping at surface-level blame.
- Corrective action tracking: documents specific actions, owners and due dates to ensure follow-through.
- Regulatory compliance: meets WHS Regulation requirements for incident notification, investigation and record-keeping.
- Organisational learning: investigation findings can be shared across sites to prevent similar incidents elsewhere.
- Legal protection: thorough documented investigations demonstrate due diligence and reasonable practicable steps.
- Continuous improvement: trend analysis of root causes drives systemic improvements in safety management.
Benefits of digitising forms in MapTrack
When you move your reports from paper to MapTrack, you get:
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- Restrict permissions (who can view, complete or approve).
- Build forms with AI (describe what you need and MapTrack suggests the form).
- Escalate critical hazards instantly to safety managers via push notification.
- Maintain an auditable safety register that satisfies WHS regulator requests.
- Correlate incident trends across sites with built-in safety analytics.
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What to include in a incident investigation and root cause analysis form
This incident investigation and root cause analysis form covers 10 key areas:
- Incident details: date/time, location, type (injury, near miss, property damage, environmental), severity (actual and potential), persons involved.
- Timeline of events: chronological sequence of events leading up to, during and after the incident.
- Immediate response: first aid, emergency services, area secured, notifications made.
- Evidence: photos, CCTV footage, equipment condition, environmental conditions, documents reviewed.
- Witness statements: name, role, statement, contact details (at least 2 witnesses where available).
- 5 Whys analysis: structured progression from immediate cause to root cause.
- Contributing factors (ICAM): absent/failed defences, individual/team actions, task/environmental conditions, organisational factors.
- Root causes: the underlying systemic issues identified.
- Corrective actions: description, type (eliminate/engineering/admin/PPE), owner, due date, priority, status.
- Follow-up: verification date, verified by, effectiveness assessment.
How to use this incident investigation and root cause analysis form
- Secure the scene and gather initial information, including photos, witness names, equipment condition and environmental factors.: Preserve the scene as it was at the time of the incident. Take photographs from multiple angles. Note the positions of equipment, materials and people. Collect the names and contact details of all witnesses. Record weather, lighting and any other environmental conditions that may have contributed.
- Interview witnesses separately and as soon as practical after the incident. Record statements in their own words.: Interview each witness individually in a private, non-threatening setting. Ask open-ended questions and let them describe events in their own words. Do not lead or suggest answers. Record or write the statement and have the witness review and sign it for accuracy.
- Build the timeline of events. Map out the sequence from normal operations through to the incident and immediate response.: Use the witness statements, photos, CCTV footage and any available records (permits, logs, checklists) to reconstruct the sequence of events. Note the time of each key action or decision. Identify the point at which normal operations diverged toward the incident.
- Apply the 5 Whys or ICAM analysis to identify contributing factors and root causes. Do not stop at human error.: Start from the immediate cause and ask why it occurred. Continue asking why at each level until you reach a systemic root cause such as a missing procedure, inadequate training, poor design or insufficient supervision. Use the ICAM framework to categorise factors into absent defences, individual actions, task conditions and organisational factors.
- Develop corrective actions for each root cause. Assign owners, set due dates and prioritise by risk and feasibility.: For each root cause, define a specific corrective action that addresses the systemic issue. Assign a named person as the owner, set a realistic due date and prioritise actions using the hierarchy of controls. Track each action to completion and verify its effectiveness.
- Complete the investigation report, share findings with relevant stakeholders, and schedule follow-up to verify corrective action effectiveness.: Write a clear summary of the investigation findings, root causes and corrective actions. Share the report with site management, the safety committee and affected workers. Schedule a follow-up review at 30, 60 or 90 days to verify that corrective actions have been implemented and are effective.
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Get the free templateEnter your email above to download the full incident investigation and root cause analysis form as a PDF.Back to download formHow often should you complete this report?
An incident investigation should be conducted after every workplace incident, including injuries, near misses, property damage and environmental events. Under the WHS Act, notifiable incidents (death, serious injury or illness, dangerous incident) must be reported to the regulator immediately and the scene preserved until an inspector arrives or directs otherwise. The investigation should commence as soon as practicable after the scene is safe and evidence has been preserved. Most organisations aim to complete the investigation within five working days for minor incidents and within 48 hours for serious events. Corrective action verification should be scheduled at 30, 60 or 90 days depending on the complexity of the actions.
Frequently asked questions
Applicable regulatory standards
This template aligns with the following regulations and standards:
- WHS Act 2011 Part 3 - Incident notification
- WHS Regulations Chapter 3 Part 3.3 - Incident notification
- Safe Work Australia - Code of Practice: How to Manage Work Health and Safety Risks
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