Free Supervisor’s Accident Investigation Report Template
Supervisor’s Accident Investigation Report
1. Employee Information
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Employee Name: Davion Barton
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Job Title: Machine Operator
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Department: Manufacturing
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Date of Accident: October 1, 2050
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Time of Accident: 10:30 AM
2. Accident Description
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Location of Accident: Machine Shop, Section 3
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Type of Injury: Laceration on the right hand
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Body Part Injured: Right hand, index finger
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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
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Immediate Cause: The safety guard was not properly positioned over the machine.
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Contributing Factors:
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Lack of proper machine maintenance (safety guard was loose).
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Employees did not follow standard operating procedures by bypassing the safety guard.
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4. Preventative Action
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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.
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Long-term Action:
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The machine will be inspected and repaired to ensure the safety guard functions correctly.
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Retraining will be provided for all machine operators on the proper use of safety equipment and adherence to procedures.
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A review of safety procedures will be conducted monthly to ensure compliance.
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5. Recommendations for Future Prevention:
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Conduct regular safety inspections of all equipment.
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Implement a more stringent process for machine maintenance and safety checks.
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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