Serious Incident – Title

Incident Key Findings

Region: • Summarize important findings from the investigation –
Country/Date: / dd-MMM-yy not necessary to include every finding, but focus on key
Description: [brief description of what happened; no contributing factors.
names – individuals or company] • Where relevant, highlight protective strategies and
Actual Severity: actions that lessened incident consequence.
Worst Potential Severity: • Make sure you dig deep to get to root causes.
JSIMS AI: • If risk assessment and pre-task planning was not done,
find out why.
• If safety absolutes or life-saving protocols were ignored,
find out why.

Lessons Learned
• Summarize the important lessons and messages. Be
specific and avoid generalities like “workers need to
Insert suitable photo take more care”.
• Focus on higher order actions (i.e. design, engineering
solutions, safety devices) and on our leadership and
management role, rather than administrative controls.
• What can we do to prevent this incident from recurring
across all locations?