Supervisor%E2%80%99s Accident Investigation Report Template
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Supervisor’s Accident Investigation Report

1. Employee Information

  • Employee Name: Davion Barton

  • Job Title: Machine Operator

  • Department: Manufacturing

  • Date of Accident: October 1, 2050

  • Time of Accident: 10:30 AM

2. Accident Description

  • Location of Accident: Machine Shop, Section 3

  • Type of Injury: Laceration on the right hand

  • Body Part Injured: Right hand, index finger

  • Witnesses: Jean Harris (Co-worker), [Your Name] (Supervisor)

Describe What Happened:

Davion Barton was operating the press machine when his right hand came into contact with the machine blade, resulting in a deep laceration on his index finger. The safety guard was not engaged, allowing his hand to enter the danger zone of the machine.

3. Cause of the Accident

  1. Immediate Cause: The safety guard was not properly positioned over the machine.

  2. Contributing Factors:

    • Lack of proper machine maintenance (safety guard was loose).

    • Employees did not follow standard operating procedures by bypassing the safety guard.

4. Preventative Action

  • Short-term Action: The injured employee was taken to the onsite medical facility for first-aid treatment. The machine was immediately shut down, and safety signage was placed around the area to prevent further use until repaired.

  • Long-term Action:

    1. The machine will be inspected and repaired to ensure the safety guard functions correctly.

    2. Retraining will be provided for all machine operators on the proper use of safety equipment and adherence to procedures.

    3. A review of safety procedures will be conducted monthly to ensure compliance.

5. Recommendations for Future Prevention:

  • Conduct regular safety inspections of all equipment.

  • Implement a more stringent process for machine maintenance and safety checks.

  • Increase supervision and monitoring of machine operators to ensure compliance with safety protocols.

6. Employee’s Statement:

"I was rushing to meet production goals and thought it would save time to work without the guard. I realize this was a mistake."

7. Supervisor’s Comments:

The employee bypassed the safety guard, which is a clear violation of safety policies. Proper machine maintenance and regular inspections are necessary to prevent such incidents. Additional training will help reinforce the importance of safety procedures.

Investigation Completed By: [Your Name]
Job Title: Supervisor
Date: October 2, 2050

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