Incident Investigation Report

Employee Legal Name

Gender

Country of Origin

Date of Birth

Age

Volunteer?

Canada
Mailing Address

WorkSafeBC Case Number

Local Address

Same as Mailing?

Department

Length of Service

Length of Service in Department

Years

Years

Months

Months

Ski Area

Province

BC
Job Title

If Other, please specify.

Date of Incident

Time of Incident

Date Reported

Reported to (Employee Name/Title)

Classification of Incident

Was the employee on a ride break?

Was the employee on a designated run?

Time Reported

Incident While Performing

Was the employee working at the

time of the incident?

Shift Start Time

Were the employee's actions for the

purpose of work?

Location of Incident

Building

Lift

Run

Road

Conditions (If applicable)

Run Type

Density

Weather

Lighting

Temperature

Conditions

Snow

Equipment & Ability (If applicable)

Equipment

Binding Release

Lessons

Ability

Helmet

Body Part Injured

Specific Description

Type of Injury
Specific Description

Incident Description

Describe what happened in detail including the sequence of events which preceeded the incident. Where appropriate use weights and measurements and reference
any additional images (e.g. photos, drawings, etc.)

Primary Cause (What action or failure to act directly caused the incident?)
Mechanical Factors

Human Factors

Management Factors

Environmental Factors

Add Brief Description of Primary Causes

Additional Factors (What are the basic fundamental reasons for the existence of these acts and/or
conditions?) (Choose all that apply)
Mechanical Factors

Human Factors

Management Factors

Environmental Factors

Add more information if necessary.

What remedial action has been or will be taken to prevent recurrence?

Review incident details at management meeting

Completion Date

Responsibility

Approved By

Completion Date

Responsibility

Approved By

Communicate action items to associates

Other remedial actions that have or will be taken to prevent recurrence?

Witness(es)

Contact Info

1. Enter full name here

Enter Contact Details

Enter witness statement

2. Enter full name here

Enter Contact Details

Enter witness statement

First Aid Attendant

First Aid Contact info

Form completed by:

List all the people that were involved in this investigation (including the Joint Occupational Health and Safety Committee (JOHSC) representative)

Include any additional comments or information here

version: Y12M05D11

Copyright 2012 go2 Tourism HR Society

USER GUIDE
Initialization

1) ADD LOGO. On your first opening of the sheet you can add a custom logo of you
will be placed in the upper right and corner of the sheet. The logo has a height of 6
to remove the logo click "Delete Logo". Logo's must be in JPEG(JPG), bitmap (BMP
afterwards.

2) When you complete and capture your first report the sheet will automatically
"AllIncidents.xls" that stores information on all reports you capture. It is located in
Investigation report.xls" . Moving this workbook from the current directory without
copies of the file and should be avoided.

3) There are a number of macroes in this workbook that are completely safe. Acces
modify files and because of this you may need to turn your macro security to low.
Fill in Information

1) When a new record is started the first field you should change is the employee's
drop down menu with the most common positions pertaining to that department.
most common.
2) Mandatory fields are coloured to help prompt you. Fill in each section with the
put NA in it.

Click to Choose
Some fields are only populated if you use the "Click to Choose" button and select o
checkboxes. When you press "Okay" the selected options will be saved to the field

Drop Down List

For fields with a limited number of valid options, drop down lists are connected to t
to view and select your value.

More Information and Examples

These buttons create pop ups that provide example s and more explanation of wha

3) Remedial Action Section. This section is completed using 2 different controls. Fi

future actions that will be implemented to help avoid a recurrence. These selection
for completion as well as who is assigned to and who authorized the action. To fill i
date field for that row and simply press the "Choose Date" button and select the d
cell you want filled in.
After Completion
There are 4 buttons on the sheet that aid in completing the process.

1) The save button can be used to save the sheet if you need more time or informa
the report but you must save the file in the same directory as the original t

2) The print button will open the print dialog to select your preferred printer. Using

After Completion
There are 4 buttons on the sheet that aid in completing the process.

1) The save button can be used to save the sheet if you need more time or informa
the report but you must save the file in the same directory as the original t

2) The print button will open the print dialog to select your preferred printer. Using
appropriately in case the form gets overly long.

3) The E-Mail button should be used if you have Microsoft Outlook setup on your co
pop up box and select OK. A security warning will pop up. Select yes when the opt
disabled copy of the sheet to the addresses selected. If Outlook isn't open then the
Outlook is opened. If you don't have Outlook installed it is recommended to prin
mail it.

4) The Capture Data button is the last step in the process. This will transfer all pert
"AllIncidents.xls". This will also prompt to clear the sheet of data and you should se
should not capture the same data to the database again as this will cause d
imperative to change data for an entry the "AllIncidents.xls" file can be modified.

custom logo of your choice. Click on "Add Logo" and the logo
go has a height of 60 pixels and a variable width. Should you want
(JPG), bitmap (BMP), or GIF fomats. You can save the template

will automatically create a separate workbook named

re. It is located in the same directory as the "Incident
t directory without moving the AllIncidents file will create multiple

pletely safe. Access to the file system is needed to create and

o security to low.

e is the employee's department. This will populate the Job Title

that department. All the remaining positions are listed after the

h section with the pertinent information. If a field doesn't apply

button and select options. This button pops a menu up with

e saved to the field.

are connected to the cell. Click the arrow button on the right side

explanation of what is requested.

fferent controls. First select the "Click to Choose" and choose all
ce. These selections will auto-fill rows. Each row will have a date
the action. To fill in the date, select the cell corresponding to the
on and select the desired date. It's important that you select the

ess.

ore time or information to complete the form. You can rename

as the original template.

erred printer. Using this function will format page breaks

ess.

ore time or information to complete the form. You can rename

as the original template.

erred printer. Using this function will format page breaks

k setup on your computer. You can add e-mail addresses to the

t yes when the option becomes available. This will send a macro
isn't open then the messages will be saved in the outbox until
commended to print the sheet to a PDF format and manually e-

will transfer all pertinent data to a central sheet called

a and you should select yes. Once you have captured data you
as this will cause duplicates and skew historical information. If it's
can be modified.

FAQ

1) I don't use Outlook, can I still e-mail the form?

Excel can only use Outlook and Microsoft Live Mail to send e-mails. If you don't use these
as a PDF using the print button and attach this file using the normal methods in your regula

2) I'm using Outlook but the e-mails aren't sending.

If Outlook is not actually running then the e-mails will be placed in the Outbox until you s
ensure you select "Yes" to the security warning.

3) Can I move or save my Incident Investigation workbook under a different name?

You can rename and save the workbook for each incident but the directory you save the fi
not move the workbook. It is recommended you use the original file as a template and sav

4) What if I don't have the information when I start to fill out out the form?
Using the "Save" button, save the file under a unique name in the same folder as the tem
many times as necessary to collect all the mandatory information. Once you have used the
longer be editted. See note 9 for details.

5) What is the AllIncidents.xls file?

This file contains data for each incident you saved and is meant for gathering data to help
processes where incidents occur.

6) Can I move or delete the AllIncidents file?

This file must remain in the folder where your reports are saved. If you move it or delete i
lose all the previous report data.
7) What happens when I capture data in the Incident Investigation report?
The data is saved in the AllIncidents file for future reference.

8) What if I accidentally capture the data twice?

Avoid this if possible but if it occurs either ignore the data when creating historical reports
See below for more information.

9) What if I captured the report but realized there was a mistake. Can I edit the AllIncidents
It is possible to modify the file. The sheet has been protected to avoid accidental data los
menu and click the "Unprotect" button. No password is needed. Modify your sheet and the

10) How can I place a filter on the Sheet data?

Unprotect the sheet as above. Select all the data in the workbook . Go to the "Data" tab in th
first row will contain filter functions that will allow you to choose what to search for in each

11) What version of Excel is the form compatible with?

The form was developed for Excel 2003 and upward. Functionality can't be guaranteed fo

12) The form is having errors on opening!

Ensure your turn your macro security to low. To find out how to do this search "enabling E
browser but sub the version you are using into the year.
13) Why is the form printing strangely?
The form has a number of functions that change the length and format of the form and the native
breaks properly. The "Print Form" button automatically reformats the page for printing on 8.5"x11"
form.

12) The form is having errors on opening!

Ensure your turn your macro security to low. To find out how to do this search "enabling E
browser but sub the version you are using into the year.
13) Why is the form printing strangely?
The form has a number of functions that change the length and format of the form and the native
breaks properly. The "Print Form" button automatically reformats the page for printing on 8.5"x11"
form.

ou don't use these then the best option is to print the file
hods in your regular e-mail program.
Outbox until you start the Outlook program. Please

ent name?
ory you save the file in must remain the same. You can
a template and save copies of each incident if necessary.

m?
e folder as the template. The form can be updated as
you have used the "capture" button the form should no

hering data to help you to identify and improve areas or

move it or delete it, another one is created but you will

t?

g historical reports or you can modify the AllIncidents file.

edit the AllIncidents file?

accidental data loss. Go to the "Review" tab in the upper
your sheet and then hit the "Protect" button above.

he "Data" tab in the upper menu and select filter. The

search for in each column.

t be guaranteed for versions older than that.

search "enabling EXCEL 2003 macros to run" in your web

form and the native excel print function may not interpret page
printing on 8.5"x11" sheets and should be used to print the

search "enabling EXCEL 2003 macros to run" in your web

form and the native excel print function may not interpret page
printing on 8.5"x11" sheets and should be used to print the