Such an incident investigation must be initiated as promptly as
possible, but not later than 48 hours following the incident. The
investigation must be by a team consisting of at least one person
knowledgeable in the process involved, including a contract employee
if the incident involved the work of a contractor, and other
persons with appropriate knowledge and experience to investigate
and analyze the incident thoroughly.
An investigation report must be prepared including at least:
• Date of incident,
• Date investigation began,
• Description of the incident,
• Factors that contributed to the incident, and
• Recommendations resulting from the investigation.