Free Fall from Height Incident Report Template

Fall from Height Incident Report


I. Incident Overview

A. Incident Details

  • Date and Time: May 15, 2050, 10:30 AM

  • Location: Construction Site, Block C

  • Weather Conditions: Clear skies, moderate wind

  • Type of Fall: Loss of Balance

  • Height Fallen: 5 meters

  • Description: Employee slipped while climbing a ladder to access the scaffold.

B. Personnel Involved

  • Employee: John Smith

  • Job Title: Construction Worker

  • Experience Level: 3 years

  • Training Records: Completed Fall Prevention Training in 2048.

II. Investigation and Analysis

A. Root Cause Analysis

Immediate Cause:

Wet surface due to recent rain

Underlying Causes:

  • Lack of Fall Protection Equipment

  • Inadequate Safety Training

B. Contributing Factors

Work Environment Factors:

  • Wet surface

  • Absence of anti-slip mats

Human Factors:

  • Rushing to complete tasks

  • Failure to use safety harness properly

C. Findings

Observations:

  • No anti-slip mats near the ladder

  • Safety harness not properly secured

Recommendations:

  • Install anti-slip mats in high-traffic areas

  • Conduct refresher training on safety harness usage

III. Corrective Actions

A. Short-Term Actions

  1. Provide First Aid to John Smith.

  2. Secure the ladder and scaffold to prevent further accidents.

  3. Document the incident scene.

B. Long-Term Actions

  1. Revise Safety Policies to mandate the use of anti-slip mats.

  2. Conduct monthly safety training sessions.

  3. Implement regular safety audits.

IV. Follow-Up and Monitoring

A. Follow-Up Measures

Employee Follow-Up:

  • John Smith received medical treatment and is under observation.

  • Counseling was provided for psychological support.

Safety Measures Follow-Up:

  • Regular safety meetings are scheduled to discuss incident prevention.

B. Monitoring Plan

  • Weekly safety inspections will be conducted.

  • Quarterly reviews to assess the effectiveness of safety measures.

V. Conclusion

Based on the findings and analysis, it is evident that the fall from height incident was primarily due to the wet surface and inadequate safety measures. Implementing the recommended corrective actions will significantly reduce the risk of similar incidents in the future.


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