Incident cause analysis method (icam) template checklist

Template Information

This icam investigation report checklist is used to assist in the investigation of incidents, accidents and near misses in the field and has been used extensively across the aviation, rail, road, mining and petroleum sectors. icam is the incident cause analysis method, an industrial safety initiative that provides the ability to identify what really went wrong and to make recommendations on necessary remedial actions to reduce risk and build error-tolerant defences against future incidents. use this template as an example to build out a holistic safety solution appropriate for your organisation.

Category: general

Template Questions

  • 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
  • Date & Time Date
  • Activity
  • 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 it happen?
  • Actual Consequence
  • Potential Consequence
  • The contributing factors of this incident were analyzed using the Incident Cause Analysis Method (ICA
  • The situations, systems, conditions, equipment, measures or human factors which normally prevent this
  • Absent or Failed Defences
  • Organisational factor type
  • Details of defence
  • The errors or violations made by people directly involved in the event.
  • Individual or Team Actions
  • Details of Action
  • The "situational characteristics" which existed immediately prior to the incident, including the work
  • Task or Environment Conditions
  • Details of Condition
  • The latent system based factors present before the incident which may have contributed to the presenc
  • Details of Factor
  • What are we going to do about the incident? Use the Hierarchy of Control recommendations for correcti
  • Enter recommended corrective actions here
  • CAR detail
  • Enter Lessons Learned here
  • Lesson
  • ICAM Report Author