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    Incident and Near-Miss Investigation Report Template (OHS Act and MHSA)

    A report that records what happened in an injury, near miss, property damage or environmental incident, what was done at once, why it happened and what will stop it happening again. The supervisor starts it on the day; the SHEQ manager and the investigation team finish it.

    Started on the day of the incident, whatever its severity, and closed only when every corrective action in the last table is verified. The reporting duties under the OHS Act and the MHSA run from the moment the incident happens, so report first and investigate after.

    Legal basis checked 26 October 2026

    Two workers in hard hats and hi-vis inspecting precast concrete in a yard

    What is in the template

    Incident details

    • Date and time of incident
    • Exact location
    • Type (injury, near miss, property damage, environmental)
    • Persons involved (name, employer, occupation)
    • Injury and treatment given
    • Reported to (name, role, date and time)

    Reporting and investigation deadlines

    • OHS Act workplace: reportable under section 24 (Y/N); reported to the Department of Employment and Labour on (date and time)
    • Recorded on Annexure 1 of the General Administrative Regulations (date)
    • Injury on duty: W.Cl.2 sent to the Compensation Fund (date)
    • Mine: regulation 23.1 category (a) to (e), or the regulation 23.4 dangerous occurrence
    • Mine: Principal Inspector of Mines told (date, time and how)
    • Mine: SAMRASS forms sent (form numbers and dates)
    • Mine: section 11(5) investigation started (date; within 10 days)
    • Mine: report delivered to the Principal Inspector and the health and safety committee (date; within 30 days)
    • Scene left undisturbed until released, where section 11(8) applies (Y/N; released by)

    The clocks run from the incident, not from the investigation. On a mine, accidents in categories (a) to (c) of regulation 23.1 and dangerous occurrences are reported immediately by the quickest means and confirmed on SAMRASS forms, category (d) within 3 days, and category (e) monthly on SAMRASS 4; the supplementary SAMRASS forms of regulation 23.3 are due within 14 days. The register of reportable accidents and dangerous occurrences is kept for 2 years (regulation 23.7).

    Description and immediate actions

    • What happened, in sequence
    • Task being done and the equipment, substance or condition involved
    • Immediate actions taken to make the area safe
    • Witnesses (name and contact)
    • Evidence collected (photos, statements, records)

    Write what was seen and said, not what was concluded. Conclusions go in the root cause section.

    Root cause

    • 5-Whys summary (why, why, why, why, why)
    • Contributing factors (people, equipment, environment, procedure, management)
    • Root cause

    Keep asking why until the answer is something the site controls: a procedure, a design, a decision, a resource. "Operator error" is not a root cause.

    Corrective actions

    Columns: Action · Owner · Due · Closed (date) · Verified by · 8 rows per page

    One action per row, one owner per action. Copy every row to the corrective-action register so it is tracked after this report is filed.

    How to fill it in

    1. 1Fill in the incident details and the description on the day, from the people who were there, before the area is cleared and memories change.
    2. 2Report before you investigate. Decide the same day whether the incident is reportable under the OHS Act section 24 or the MHSA, and whether an injury on duty needs a W.Cl.2 to the Compensation Fund.
    3. 3Work through the 5-Whys with the supervisor and at least one worker from the area, and write each why down.
    4. 4Separate contributing factors from the root cause. Several things usually lined up; one of them is the thing to fix.
    5. 5Give every corrective action an owner and a due date, copy it to the corrective-action register, and close the report only when each action is verified by someone other than the owner.

    A general template, not legal advice. Check it against the Act, the regulations and the codes of practice that apply to your site, and against your own safety management system. The OHS Act section 24 requires certain incidents to be reported to the Department of Employment and Labour, and regulations 8 and 9 of the General Administrative Regulations require incidents to be reported, recorded and investigated, with Annexure 1 as the record. Under the MHSA, section 11(5) requires the employer to investigate accidents, serious illnesses and health-threatening occurrences, section 11(5)(e) and 11(5A) set the 30-day report and completion deadlines, section 11(8) protects the scene of an accident that kills or is likely to kill or that costs a limb, and Chapter 23 of the MHSA regulations (reporting of accidents and dangerous occurrences, regulations 23.1 to 23.7) requires them to be reported to the Principal Inspector of Mines. An injury on duty is reported to the Compensation Fund on form W.Cl.2 under COIDA.

    Legal basis checked on against: Mine Health and Safety Act, 29 of 1996, sections 11(5), 11(5A) and 11(8); Mine Health and Safety Act regulations, Chapter 23 (regulations 23.1 to 23.7).

    Convert this template into a digital form

    Run it on an Android phone with no signal, attach photos as evidence, and every failed item raises an issue with an owner and a due date.

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    The same record in Inspecable

    On paper the register is only as current as the last person who updated it. In Inspecable the same record keeps going:

    Do it in InspecableCorrective actions

    Questions

    Which incidents must be reported in South Africa?

    Under the OHS Act section 24, any incident where a person dies, is likely to die, loses a limb or consciousness, or is off normal work for 14 days, and the listed dangerous occurrences. A mine reports under the MHSA regulations to the Principal Inspector of Mines. Report first and investigate after; the two duties run separately.

    What is the difference between a contributing factor and a root cause?

    A contributing factor is anything that made the incident more likely or worse: a worn tool, fatigue, poor light, a shortcut. The root cause is the one underlying failure that, if fixed, stops the incident recurring, usually a procedure, a design, a decision or a resource. Fix the contributing factors too, but name one root cause.

    Who should investigate an incident?

    A small team led by someone who did not supervise the work: the SHEQ manager or an appointed investigator, the area supervisor, a worker from the area and a health and safety representative, who is entitled to take part under both Acts. On a mine the employer must investigate under the MHSA section 11(5).

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