Employer Incident Investigation Report (Full) Employer Incident Investigation Report (EIIR) – FULL Step 1 of 4 25% A Full Investigation Is Required. Select on of the following:* Complete the full investigation now Save and continue later (within 30 days) Email the Full Investigation task to someone else Please review the Preliminary Report by pressing "Next" Worker InformationHiddenIncident ID # HiddenDistrictFirst ChoiceSecond ChoiceThird ChoiceWorker's Name First Last PositionFirst ChoiceSecond ChoiceThird ChoiceHiddenEmployee Number*Incident Date MM slash DD slash YYYY Incident Time : Hours Minutes AM PM AM/PM Witnesses and others with relevant informationNameRelation/Position Incident Type* Workplace Accident Reportable Behaviour Violent Incident Injury Type Near Miss Injury/illness Gradual onset Incident Causes and Corrective MeasuresStatement of the sequence of events that preceded the incidentBrief description of the incidentInterim Corrective Action TakenIdentification of any unsafe conditions, acts or procedures that significantly contributed to the incidentInterim corrective actions to prevent the recurrence of similar incidents until full investigation is completedWho will act First Last Job Titlie Date action taken MM slash DD slash YYYY Full InvestigationDate of investigation MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Are there any other persons actively involved in the accident or incident, or persons implementing the corrective action* Yes No Other involved in the full investigationNameJob Title Full Investigation Corrective Action ReportIdentification of any unsafe conditions, acts or procedures that have not been identified in the Preliminary Investigation*Corrective actions to prevent the recurrence of similar incidents until full investigation is completed*Who will act* First Last Job Title By What Date* MM slash DD slash YYYY Name of Investigator (Full Investigation) First Last Job Title Name of Worker Rep on JHSC (Full Investigation) First Last Job Title Worker Rep Email*
