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Run: Fall Investigation Root Cause Analysis

Use this Fall Investigation Root Cause Analysis template to document what happened, why it happened, and what corrective actions will prevent another major i...

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Incident Overview

Date and time of fall documented critical (required)

Note (optional)

Location of fall documented with specific area critical (required)

Injury severity classified and major injury confirmed critical (required)

Note (optional)

Immediate medical response initiated critical (required)

Yes No N/A

Witnesses identified and interviewed

Yes No N/A

Event Sequence and Timeline

Pre-fall activity documented critical (required)

Timeline includes last known safe condition and discovery time critical (required)

Contributing events immediately before the fall identified

Post-fall assessment and notifications completed critical (required)

Yes No N/A

Human Factors and Supervision

Required supervision or assistance was provided critical (required)

Yes No N/A

Fall risk status and precautions were current and communicated critical (required)

Yes No N/A

Staffing level and workload were adequate at the time of the event

Communication breakdowns identified

Root Cause Analysis and Corrective Actions

Primary root cause identified critical (required)

Contributing system factors identified critical (required)

Note (optional)

Corrective actions assigned with owner and due date critical (required)

Follow-up monitoring plan defined

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Run: Fall Investigation Root Cause Analysis

Incident Overview

Event Sequence and Timeline

Environmental and Equipment Factors

Human Factors and Supervision

Root Cause Analysis and Corrective Actions

Get your results