Lumiform Mobile audits & inspections
Get App Get App

Use an incident cause analysis method (ICAM) investigation template to address incidents

Incident Cause Analysis Method (ICAM) Template is a tool that assists organizations with analyzing and understanding the causes of an incident. It helps to identify the root cause of the problem and assists organizations in making corrective and preventive actions. It also helps organizations to anticipate future incidents.

Downloaded 809 times

Rated 5/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates

Digitalize this paper form now

Register for free on and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra

Use an incident cause analysis method (ICAM) investigation template to address incidents

Incident Details

Incident Summary

Collect information and evidence of the incident and report your findings here.
Item detail
Photo evidence


List the activities and events leading up to the time of the incident, when the incident happened and what took place afterwards.
Date & Time

Analysis Overview

The basic cause of an incident is the mechanism of failure.
What happened?
The ICAM model analyses the contributing factors to determine why the incident happened.
Why did the incident happen?
Actual Consequences
Potential Consequences

ICAM Analysis

The contributing factors of this incident were analyzed using the Incident Cause Analysis Method (ICAM) process, an industrial safety initiative used to analyze serious incidents. ICAM is an analysis tool that sorts the findings of an investigation into a structural framework. An ICAM analysis clarifies why the incident happened and identifies all the factors that contribute to the event. The contributing factors are classified into four categories of the ICAM model which are: Absent or Failed Defences; Individual or Team Actions; Task or Environmental Conditions; Organisational Factors.

Absent or Failed Defences

The situations, systems, conditions, equipment, measures or human factors which normally prevent this type of incident from happening.
Absent or Failed?
Organisational factor type
Details of defence

Individual or Team Actions

The errors or violations made by people directly involved in the event.
Individual or Team?
Organisational factor type
Details of Action

Task or Environment Conditions

The "situational characteristics" which existed immediately prior to the incident, including the work situation, physical or social environment, or a person's mental, physical or emotional state.
Task or Environmental
Organisational factor type
Details of Condition

Organisational Factors

The latent system based factors present before the incident which may have contributed to the presence of specific adverse task or environmental conditions, individual or team actions, or absent or failed defences.
Organisational factor type
Details of Factor


Recommended Corrective Actions

What are we going to do about the incident? Use the Hierarchy of Control recommendations for corrective actions that will target prevention of recurrence and reduction of risk. The recommendations will address each identified absent or failed defence (risk controls) and Organisational factor (prevention and risk reduction strategies).
Enter recommended corrective actions here
CAR detail

Key Learnings

Enter Lessons Learned here
Lesson Learned

Sign off

Full name and signature of ICAM report author
Share this template:

Conduct proper investigations with an incident cause analysis method (ICAM) template

The Incident Cause Analysis Method (ICAM) template is an effective problem-solving tool used by organizations to identify the root causes of an incident. It helps organizations to quickly analyze the incident, identify the root cause and develop corrective actions.

The ICAM template is used to identify the causal factors associated with an incident. It can be used to analyze any type of incident, such as an accident, medical error, or system failure. The template includes a series of questions that help to identify the cause of the incident. The questions are divided into categories and the template can be customized to your specific needs

The ICAM template is a valuable problem-solving tool that can help organizations to quickly identify the root cause of an incident and develop corrective actions. By using the template, organizations can improve their incident response process and improve their overall safety and performance.

Similar templates