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Incident Investigation Report (NZ)

Name: Incident Investigation Template NZ
Brand: OH Consultant
SKU: NZ-TPL-INV-001
Price: 129.00 NZD
Availability: InStock
Author: OH Consultant

The document that turns a reported event into a defensible finding — structured causal analysis, corrective actions ranked against the hierarchy of control, and a due-diligence trail an officer can stand behind.

⚖️Anchored to GRWM Regs 6 & 7

👷Reviewed by OH Professionals

✏️Editable .docx

NZD 129

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Instant download · Editable .docx

An investigation that stops at "worker did not follow procedure" has found a person, not a cause. It produces a corrective action at the bottom of the hierarchy of control — retraining, a reminder, a toolbox talk — and the same event recurs. This template forces the analysis past the immediate act into the conditions that allowed it, then requires each corrective action to be placed on the GRWM Regulation 6 hierarchy so that administrative fixes have to be justified rather than defaulted to.

Investigations stop at human error

Naming the person closest to the event feels like a finding. It is where the analysis should start, not finish — the template structures the layers underneath it.

Corrective actions default to retraining

Regulation 6 requires elimination first, then substitution, isolation and engineering, before administrative controls and PPE. Every action in this report has to declare its level.

Officers have no due-diligence trail

Section 44 puts a personal duty on officers to verify that resources and processes are in place and used. A completed investigation file, with actions closed out and verified, is a large part of how that duty is evidenced.

Who this is for

Main contractors: Run the investigation after a notifiable event on your site, including events involving subcontractor personnel.
H&S managers and advisors: A repeatable structure so investigations do not vary in depth with whoever ran them.
Directors and officers: The due-diligence section is written for the person carrying the s44 duty, not for the file.
Businesses under insurer or client review: A structured report with verified close-out is what an insurer or principal asks to see after a serious event.

This is the investigation. The initial report and the WorkSafe notification decision are handled by the reporting form.

Incident & Near-Miss Report Form →Risk Register →

What's inside the template

Word — 16 pages (report + analysis tools + guidance) · Formats: DOCX

Section 1 — Investigation scopeLinked report number, event classification, investigation level, team, terms of reference, date commenced.
Section 2 — Evidence collectedPeople, positions, parts, paper and recordings. Chain-of-custody prompts for physical evidence and photographs.
Section 3 — Sequence of eventsTimeline reconstruction with a separate column for what was known at the time versus what is known now.
Section 4 — Absent or failed defencesWhich controls should have prevented the event, and whether each was missing, present but ineffective, or bypassed.grwm 7
Section 5 — Individual and team actionsWhat was done, and critically why it made sense to the person at the time. Structured to avoid stopping at blame.
Section 6 — Task and environmental conditionsWorkload, time pressure, tools, lighting, weather, supervision, competence, fatigue.
Section 7 — Organisational factorsProcurement, design, planning, resourcing, contractor management, training systems, culture.
Section 8 — Root cause statementA written finding that must survive the "and why did that happen" test three times over.
Section 9 — Corrective action planEach action mapped to a hierarchy-of-control level, with owner, due date, verification method and close-out signature.grwm 6
Section 10 — Officer due diligenceWhat the officer verified, when, and on what evidence.hswa 44
Section 11 — Lessons and communicationWhat is shared, with whom, and how it is confirmed to have landed.
Appendix A — Causal analysis worksheetFive-whys and contributing-factor grid, printable.
Appendix B — Investigation level matrixHow to decide whether an event gets a supervisor review or a full team investigation.
Appendix C — Interview guideNon-leading question set, with guidance on conducting interviews that produce usable accounts.

Compliance checklist

HSWA 2015 ss.36, 44, 57 · GRWM Regulations 2016 regs 5–7

Investigation is not itself a named statutory document in New Zealand. Its legal weight comes from the duties it discharges — the primary duty of care, the officer due-diligence duty, and the requirement that control measures actually remain effective.

s36Primary duty of care — ensure health and safety so far as is reasonably practicable→ Sections 4, 8 and 9 together evidence the reasonably-practicable assessment
s44Officer due diligence — verify provision and use of appropriate resources and processes→ Section 10 — Officer due diligence
GRWM reg 5Identify hazards giving rise to reasonably foreseeable risks→ Sections 6 and 7, feeding the Hazard Register
GRWM reg 6Apply the hierarchy of control measures in order→ Section 9 — every action declares its level
GRWM reg 7Ensure control measures are effective and maintained so they remain effective→ Section 4 — Absent or failed defences
s57Keep records of notifiable events for at least 5 years→ Section 1 links the investigation to the reportable record

How this template compares

Feature	Free template	Generic AU investigation form	OH Consultant (NZ)
Cost	$0	NZD 40–90	NZD 129
Legislative anchor	None	AU Model WHS	HSWA ss.36/44/57 + GRWM regs 5–7
Causal method	Five whys at best	Five whys	Layered — defences, individual, task, organisational
Hierarchy of control on actions	No	Rarely	Required field on every action
Officer due-diligence section	No	No	Yes — written for the s44 duty holder
Interview guidance	No	No	Appendix C — non-leading question set
Investigation level matrix	No	No	Appendix B
Verification of close-out	No	Sign-off only	Verification method recorded per action

Reviewed by OH Professionals

Written and reviewed by the occupational health and safety team at OH Consultant. The layered causal structure draws on established incident-analysis practice — absent or failed defences, individual and team actions, task and environmental conditions, organisational factors — adapted to New Zealand duty-holder language under HSWA 2015 rather than reproduced from an Australian or offshore model.

Legislation referenced

Frequently asked

Is an incident investigation legally required in New Zealand?+

There is no section of HSWA that says "you must investigate" in those words. The duty arises indirectly and is no less real for it: the primary duty of care under s36 requires you to ensure health and safety so far as is reasonably practicable, and Regulation 7 requires control measures to remain effective. You cannot demonstrate either after a serious event without having established what failed and why.

Which events should be investigated?+

Appendix B provides a level matrix. In general, every notifiable event warrants a full investigation; high-potential near misses — events that could readily have caused serious harm — warrant the same treatment regardless of actual outcome; and lower-consequence events are handled by supervisor review with the same corrective-action discipline.

Why does the template push back on "human error" findings?+

Because it is a description, not a cause. If the finding is that a worker made a mistake, the questions that follow are what made the mistake likely, what should have caught it, and why the defence was absent. Sections 4 through 7 exist to hold the analysis open until those are answered.

What is the officer due-diligence section for?+

Section 44 of HSWA places a personal, non-delegable duty on officers — directors and others with significant influence over the business — to exercise due diligence. Part of that is verifying that resources and processes are provided and used. Section 10 records what the officer actually verified and on what evidence, which is materially different from being told the matter was handled.

Does this replace the incident report form?+

No. The report form captures the event and drives the WorkSafe notification decision under s56. This document is what happens next, for events that warrant it, and it references the report number so the two stay linked in the five-year record.

Can I use it for a near miss with no injury?+

Yes, and you should for high-potential ones. Outcome is partly a matter of chance; potential is the better trigger for investigation effort. The level matrix in Appendix B is built around potential rather than actual consequence.