Cal OSHA: Investigation / Corrective Action Report
MaintainX
10/24/2021
Cal OSHA: Investigation / Corrective Action Report
Date and Time of Incident / Exposure
Location
Employees Involved
Detailed Incident / Exposure Description
Ultimate cause of incident/exposure (I.e. "who, what, when, where, how" and the "5 ways" the root cause)
Options for elimination or control of the root cause(s)
Witnesses:
Investigated By:
Date:
Source: Cal OSHA (www.dir.ca.gov)