Free Construction Accident Investigation Report Template
Construction Accident Investigation Report
Prepared by: [Your Name]
I. Introduction
This report investigates a construction site accident that occurred on December 20, 2050, at Project Site B, Main Street, New York City, NY. The purpose is to identify the causes of the accident, recommend corrective actions, and ensure compliance with safety protocols.
II. Incident Details
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Date and Time: December 20, 2050, at 10:15 AM
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Location: Project Site B, Main Street, New York City, NY
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Type of Accident: Fall from a height
III. Description of the Accident
A. Narrative
At approximately 10:15 AM, Javier Jacobs, a construction worker, was performing a structural inspection on the second level of a scaffolding unit when the platform collapsed. The accident resulted in the worker falling approximately 15 feet to the ground, sustaining multiple injuries.
B. Immediate Actions Taken
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Emergency services were called at 10:20 AM.
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The injured worker was transported to City Medical Center for evaluation and treatment.
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The site was secured, and scaffolding use was halted pending investigation.
IV. Witness Statements
A. Witness 1
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Name: Emmy Green
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Role: Site Supervisor
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Statement: "Javier was inspecting the scaffolding as part of routine checks. I heard a loud crack and saw the platform give way. He was wearing his safety harness, but it was not secured to the anchor point."
B. Witness 2
Name: Robert Lee
Role: Construction Worker
Statement: "I was working nearby when I noticed the platform shaking. It seemed unstable, but I didn’t expect it to collapse. I think the bolts were loose."
V. Injuries/Damages
A. Injuries
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Javier Jacobs sustained a fractured arm, a sprained ankle, and multiple contusions.
B. Property Damage
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The scaffolding platform was severely damaged and deemed unsafe for further use.
VI. Cause Analysis
A. Immediate Causes
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Loose bolts on the scaffolding platform.
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The worker did not secure the safety harness to the anchor point.
B. Root Causes
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Inadequate inspection of scaffolding before use.
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Insufficient training on the proper use of safety harnesses.
VII. Corrective Actions
A. Short-Term Measures
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Inspect all scaffolding platforms for structural integrity before resuming work.
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Provide medical treatment and support to the injured worker.
B. Long-Term Measures
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Conduct comprehensive safety training for all workers on scaffolding use and harness protocols.
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Implement a stricter scaffolding inspection checklist with daily checks by a designated safety officer.
VIII. Photos/Diagrams
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Insert a Photograph of the Damaged Scaffolding Here
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Attach diagrams of the accident scene and scaffolding structure.
IX. Conclusion
The investigation concludes that the accident occurred due to loose bolts on the scaffolding platform and the improper use of a safety harness. Implementing the recommended corrective actions will minimize the risk of similar incidents in the future.
X. Signatures and Approvals
Investigator Name: Mark Johnson
Position: Safety Officer
Date: December 21, 2050
Approving Authority Name: [Your Name]
Position: Project Manager
Date: December 21, 2050
