2850 Clover Street ● Pittsford, New York 14534
Toll Free: 800.462.6435
Tel: 585.381.8070
www.FlandersGroup.com
Accident Root Cause Analysis Form
Instructions:
1. Write down the accident event in the space in the middle of the page.
2. Determine if the accident circumstances are in the areas of People, Equipment, Environment, or
Management.
3. If there are circumstances in a particular section, ask a series of “why?” questions to determine the reasons
for every set of circumstances.
4. When you have run out of “why?” questions, analyze the results. Eliminate any unlikely causes or
circumstances that you cannot control. Identify the accident cause.
5. Determine what management system needs to be in place to assure that the accident does not happen again.
People
 Lack of procedures
 Procedures not followed
 Procedures not known or understood
 Task too difficult to perform
 PPE not used or not available
 People not trained
 Training inadequate
 Distraction, , or fatigue
Environment
 Location of employee
 Temperature extremes
 Poor lighting
 Poor housekeeping
 Inadequate ventilation
 Excessive vibration
 Excessive noise
 Condition of work surface
Equipment
 Equipment not maintained
 Wrong equipment used
 Poor equipment design
 Correct equipment not
available
Management





No management system in
place to control hazard
Supervision did not detect
unsafe conditions or behavior
Supervision did not take action
to correct unsafe conditions or
behaviors
Lack of supervisor training
Lack of accountability for
safety
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