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Event Report and Investigation Form


Whenever there’s a safety incident or near miss, it’s critical that you gather key information on the event and investigate what caused it. First, the OHS laws may require you to report the event to the OHS regulatory agency and you’ll likely need this information for that report. Second, by investigating the event and determining its cause(s), you can take appropriate steps to ensure that similar events don’t happen again in the future.


Adapt this form, which was provided by Roche Diagnostics, for your OHS program, operations and the requirements of your jurisdiction’s OHS laws on incident reporting. Ensure that all staff—especially supervisors and managers—are trained on how to use it after a safety incident or near miss. The form is provided in both English and French.