Laboratory Accident Investigation Report
Basic Information
Report Date
Reported by
Laboratory/Location
Date of Accident
Time of Accident
Incident Description
Describe the accident
Equipment/materials involved
Persons involved (names and roles)
Injury / Damage Details
Nature and extent of injury/damage
Treatment or action taken
Cause Analysis
Direct causes
Root causes
Corrective Actions
Immediate corrective action(s) taken
Recommended long-term preventive measures
Person(s) responsible for implementing recommendations
Date for completion of corrective actions
Investigator Information
Name of Investigator(s)
Date of Investigation