OHS Safety Sprint: Survey for the Cause-Incident-Measure-Map (CIMM)
This structured survey consists of 12 chapters for the anonymous determination of the causes that played a role in the occurrence of the incident:

1.) mechanical hazards
2.) electrical hazards
3.) hazardous substances
4.) biological hazards
5.) fire or explosion hazards
6.) thermal hazards
7.) physical hazards
8.) work environment stresses
9.) limitations of the human physique
10.) psychological stresses
11.) organisational hazards
12.) miscellaneous hazards

While filling in the questionnaire, the answer NO on any of the chapter introductory questions will cause the skip of the detailed analysis for that chapter.


Notes:

+ This questionnaire is generated individually for every case that is investigated. The questionnaire will be closed when all the contributing witness have filled in the form.

+ The filling in of the questionnaire will be conducted by each witness or participant without the influence of other participants, witnesses or superiors.

+ The questionnaire is recorded anonymously, no IP addresses, e-mails or other form of identification is used to track or identify the comments of a participant.

+ The Umpire will receive all the information from this survey without knowing the person who submitted it. During the conduction of the OHS Safety Sprint Session the umpire is advised not to quote the answers given directly when attempting to generate a joint view on the matters for the OHS Safety Sprint - Cause-Incident-measure-Map (CIMM).

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