• Incident Report Non-Injury

Incident Reporting

Emergency Dial 911If you are currently experiencing an actual emergency, please dial 911.

Si está experimentando una emergencia actualmente, por favor llame al 911.

Accident/Incident and Near-Miss Investigations

Accident/Incident and Near-Miss Investigations should be recorded on the County AIIR form and sent to the corresponding Safety Coordinator for the department. Additionally, AIIR's are forwarded to Risk Management within 5 working days for record keeping and program monitoring. The department IIPP defines the level of investigation that will be performed for accidents and “near miss” incidents.  The IIPP also describes the time frames for investigations, investigation responsibilities for individuals, teams or committees, and follow up procedures described.

Accident/Incident investigations are important tools used to identify safety concerns, determine how an incident could have been prevented and to make recommendations to prevent recurrences.  Departments must follow the Risk Management accident/incident investigation procedures.

Responsibility

All departments must conduct effective accident/incident investigations to identify the root cause of the accident/incident and to implement adequate control measures.  Accident /incident investigations must be reviewed periodically by department management to determine that thorough investigations are conducted by supervisors and deficiencies in the safety management system are identified.  Opportunities for improvement from investigations can be used for planning and corrective action.

Department Safety Coordinators are responsible to review the investigation report for accuracy and completeness.  In addition, the Department Safety Coordinator will collaborate with the Supervisor or Manager in developing recommendations, taking corrective action to prevent future recurrences, and elevating safety concerns to the Department Head.  Accident/Incident Investigations are forwarded to Risk Management within 5 working days for record keeping and program monitoring.

Accident/Incident Investigation Report
(PDF: 172 kB)

Instructions for Completing Accident/Incident Investigation Report
(PDF: 87 kB)

Return to Report an Incident

Contact Information

Safety Unit
Risk Management Division

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

Accident Incident Investigation Report