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Aramark Incident & Investigation Report
Investigations must be completed within 7 days of the injury
Hidden Claim Number
Hidden investigation Number
record type
Incident
Info
Type of Injury
Part of body injured
Side of body injured
Incident Description
What activity was being carried out at the time?
Incident Investigation
Was the equipment in use a factor in the incident?
Yes
No
Equipment
Select all that apply:
Select all that apply:
Equipment not functioning properly or in poor condition
Equipment used was not suitable for the task
Equipment not used as intended
Equipment not inspected before use
Employees not trained on use of equipment
Other
Please provide details:
Did the design, layout or condition of the workplace contribute to the incident?
Yes
No
Workplace Layout / Conditions
Select all that apply:
Select all that apply:
Inadequate layout (insufficient space, broken door, floor holes)
Work area difficult to access
Inadequate warning signs in place (ex: Wet floor signs)
Housekeeping not to standard
Other
Please provide details:
Floor Conditions
Select all that apply:
Select
Damaged floor surface (e.g. holes, uneven flooring)
Substance on floor
Obstacle on floor
Unsuitable floor mat
Defective Step(s) / Stairs
Other
Please provide details:
Environmental Conditions
Select all that apply:
Select
Lighting not adequate
Temperature not suitable (too hot, too cold)
Inadequate ventilation
Weather conditions
Other
Please provide details:
Did procedures (or lack of) contribute to the incident?
Yes
No
Procedure or lack of
Select all that apply:
Select
No procedure in place for the task
Inadequate procedure / procedure not followed
No employee training or documentation that covers this task
Insufficient information provided to contractor
Other
Please provide details:
Did Personal Protective Equipment (or lack of) contribute to the incident?
Yes
No
Personal Protective Equipment (PPE)
Select all that apply:
Select
Proper PPE not available
PPE available, but not used or maintained
PPE used, but poor fit or ineffective
Improper use of PPE
Not trained on proper use of PPE
Other
Please provide details:
Were there other contributing factors to the incident?
Yes
No
Other Contributing Factors
Select all that apply:
Select
Fatigue
Acts of violence
Stress or Rushed
Other
Please provide details:
Were they wearing Shoes for Crews?
Yes
No
Attachments & Documents
Add support documentation as an attachment :
Corrective Action
Corrective Action:
What actions have been taken to prevent this incident from happening again?’ Consider People Training, behaviors and PPE. Consider Environment design, layout and equipment.
Please select...
Reinforce proper lifting techniques and storage/handling procedures
PPE available & being utilized (cut gloves, slip resistant shoes, etc)
Better or alternative equipment to be used
Training or coaching employee on proper protocols or equipment
Equipment fixed / Work Order put in
Modifications to Job Duties or job rotation to limit repetitive stress
Implement coaching and recognition process
Increase frequency of SAFE observation with associates
Implement feedback loop for employees to share learnings, suggestions, closure, or action
Other
Person(s) Responsible
Is the Corrective Action Complete?
Yes
No
Completion Date
MM/DD/YYYY
Expected Completion Date
MM/DD/YYYY
Please Provide Details
Investigation completed by:
Origin
Email
GMM
Reminder Email