Incident cause analysis method (icam) checklist
M-ims 06.07 icam investigation [rev 1]
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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
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