Templates
Safety root cause analysis template

Safety root cause analysis template

Enhance workplace safety with our root cause analysis template. This tool helps organizations systematically identify and address safety hazards.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF
Safety root cause analysis template

Enhance workplace safety with our root cause analysis template. This tool helps organizations systematically identify and address safety hazards.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

A safety root cause analysis template guides you through systematically identifying the underlying causes of workplace incidents, not just the symptoms. This digital form helps you document incident details, assess risks, and develop targeted corrective actions to prevent recurrence. OSHA highlights that by conducting a thorough root cause analysis and addressing system failures, you can better prevent similar incidents from occurring again.

For instance, if you encounter a near-miss, the template can help you to identify whether the cause stems from procedural gaps, training deficiencies, or equipment issues. This way, your preventive measures address the true source of risk.

Related categories

Preview of the template
Incident Details
Incident date
Time of incident
Location of incident
Incident description
Risk Assessment
Hazard identified
Potential consequences
Risk level
Corrective Measures
Immediate actions taken
Root cause analysis
Recommended corrective actions
Person responsible
Target completion date

Frequently asked questions

How can I ensure my corrective actions from this template actually prevent future incidents?

Connect each corrective action directly to an identified root cause, prioritize them based on risk level, and assign specific responsibilities with clear deadlines. Follow up systematically to verify implementation and effectiveness. The best corrective actions address system weaknesses rather than simply blaming individuals or adding more rules.

What timeline should I follow when implementing corrective actions from my root cause analysis?

Immediate actions should be taken within 24-48 hours to control the hazard, while addressing root causes typically requires 1-4 weeks depending on complexity. Set realistic target dates in the template that reflect urgency but allow sufficient time for proper implementation. The most critical factor is maintaining momentum until all corrective actions are completed.

Can I use this template to analyze near-misses, not just actual incidents?

Yes, simply apply the same thorough analysis to near-misses as you would to actual incidents. Document what almost happened, potential consequences if the incident had fully developed, and identify the barriers that prevented harm. Near-miss analysis using this template provides valuable learning opportunities without the cost of an actual incident.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.