Incident investigation report INV-2026-014, forklift near miss, Quorrin Freight
Incident investigation report template for an Australian workplace near miss
An incident investigation report has to establish what happened, why it was able to happen, and what will change so it cannot happen again, with an owner for each change. This five page report on a forklift and pedestrian near miss in a New South Wales warehouse does that with a facts table, a timeline checked against telematics, four contributing factors, one root cause and six actions ranked by the hierarchy of control.
The document, page by page
Every page as it renders and as it prints, with nothing summarised. Read the wording before you reuse it.
Section by section
What each section is for, so you can keep the ones you need and drop the rest.
- Letterhead and reference block
- Company, ABN, site and the reference block.
- 1. Summary
- What happened, the finding in one paragraph and the notifiable incident assessment.
- 2. Incident facts
- Forklift, operator, pedestrian, load, conditions, walkway and witnesses.
- 3. Timeline
- Nine rows from entering the aisle to the site inspection, each with its evidence source.
- 4. Contributing factors
- Four numbered factors: layout, visibility, warning devices, procedure and training.
- 5. Root cause
- The shared intersection and the skipped layout review, and a statement that no worker was at fault.
- 6. Corrective actions
- Six actions with control level, owner and due date, and how effectiveness will be checked.
- 7. Consultation and sign off
- Duties under the NSW Act, consultation with the safety representative, and two signature blocks.
How to adapt this document
First, for an injury rather than a near miss, add a short section on first aid and medical treatment given and keep the notifiable assessment callout, because the answer may now be yes and the regulator must be told immediately. Second, for a vehicle incident on a public road or a chemical spill, keep the four factor headings but rename them to fit, such as route and schedule in place of layout. Third, if your site uses a formal method such as five whys or a causal tree, put that analysis in section 4 and keep the root cause to one paragraph a manager can repeat.
Which law the terms follow
The report is written for a New South Wales workplace under the Work Health and Safety Act 2011 (NSW). It uses that Act's duty to eliminate or minimise risks so far as is reasonably practicable, its notifiable incident definitions in sections 35 to 37, and its duty to consult workers and their health and safety representatives. The forklift guidance follows SafeWork NSW and the Safe Work Australia model code on plant and its workplace traffic management guide. Victoria runs its own Occupational Health and Safety Act 2004, with different wording, so check the state before reusing it.
What makes this document work
The notifiable decision is written down
A callout on page one records that nobody was injured or treated and no plant was damaged, so the event was assessed as not notifiable under sections 35 to 37 of the Work Health and Safety Act 2011 (NSW). If a regulator asks later, the reasoning is already on file.
The timeline names its sources
Every row says where the time came from: CCTV camera 6, the forklift telematics or a statement, and the opening note says the two clocks agreed within four seconds. A timeline built from memory alone is the first thing a reviewer questions.
Actions follow the hierarchy of control
The root cause is the shared intersection, so action 1 is a fixed barrier and a rerouted walkway, with the corner closed in the meantime. Retraining comes last, at action 6. The report says plainly that neither worker acted unsafely.
Questions people ask
Does a near miss have to be investigated?
Australian WHS law does not require every near miss to be investigated, but the duty to manage risks so far as is reasonably practicable means a near miss that shows an uncontrolled hazard should be. A forklift passing within half a metre of a person is exactly that. Investigating it costs a few hours; the same corner next time could cost a life.
What makes an incident notifiable in New South Wales?
A death, a serious injury or illness, or a dangerous incident, as defined in sections 35 to 37 of the Work Health and Safety Act 2011 (NSW). Serious injuries include those needing immediate treatment as an inpatient. Dangerous incidents include certain uncontrolled events that expose a person to a serious risk. SafeWork NSW must be told immediately, and the site preserved.
What is the difference between a contributing factor and a root cause?
A contributing factor made the event more likely, such as a blocked sightline or an alarm nobody hears. The root cause is the underlying condition that let those factors line up, here a shared intersection with no separation and a layout change that skipped review. Fixing a factor helps; fixing the root cause stops the pattern repeating elsewhere.
Should the people involved be named in the report?
Usually not in the body. This report describes the operator and picker by role and experience, which is all the findings need, and keeps names in the investigation file. Naming people in a report that goes to the whole site invites blame and makes the next person less willing to report a near miss honestly.
How do you check a corrective action actually worked?
Set the check when you set the action. Here the WHS coordinator confirms the barrier and mirrors on site in writing, and the safety committee reviews four weeks of CCTV at the new crossing in November. If the footage still shows people cutting across, the control has failed, however neatly the action was closed in the system.
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