Construction Accident Root Cause Analysis
General Information
Date of Accident
Location
Project Name
Reported By
Accident Description
Describe what happened
Immediate Consequences
Investigation Details
Persons Involved
Witnesses
Investigator(s)
Date of Investigation
Direct Causes
Direct Cause
Details
Root Causes
Root Cause
Category
Details
Human
System
Equipment
Process
Environment
Human
System
Equipment
Process
Environment
Corrective Actions
Action
Responsible
Due Date
Status
Open
In Progress
Closed
Open
In Progress
Closed
Lessons Learned
Additional Notes
Sign-off
Name
Date