Guide

How is an accident investigation carried out?

An investigation does not look for someone to blame; it looks for the root causes that would stop the event recurring, and ties each root to an action.

The purpose

The purpose is not to find the responsible person but to prevent recurrence. An investigation that ends at a person does not stop the event happening to someone else in the same conditions.

Time is critical

The investigation starts immediately after the event. The scene changes, traces disappear, memory loses its freshness. An investigation begun a week later has already lost half its material.

The team

One person does not investigate alone. Someone who knows the work, someone who knows safety, and someone from outside that department looking together reduces blind spots.

Reaching the root

The first cause found is usually the most visible. The question "why" is repeated until the answer falls outside the workplace's control; every answer that stays inside becomes a candidate for a control.

Closing

An investigation closes when its actions close. A recommendation without an owner and a date is not a closure.

In Optifora

The incident module ties the investigation to the record, builds the root cause diagram inside the file, turns each root into a corrective action, and does not close the event until the actions close.

  1. Start at onceOpen the investigation as soon as possible after the event.
  2. Form the teamBring together someone who knows the work, someone who knows safety and an outside view.
  3. Collect evidenceGather photographs, measurements, records, witness accounts and equipment condition.
  4. Seek the rootKeep asking why until the answer falls outside your control.
  5. Tie to actionsWrite an action with an owner and a date for each root cause.
  6. Close and shareClose the event when actions close; pass the lesson to similar areas.

Manage this in Optifora

Optifora is not a single program but a compliance platform assembled from modules. The catalogue states which module is ready today and which is on the roadmap.

See what Optifora is