Workplace Investigation Report Examples – Pdf | Examples Within Hr Investigation Report Template

By | May 11, 2022

PROTOCOL COMPLIANT INVESTIGATION REPORT

***Example A is the initial investigation report used in training. Read through it first, note questions you would have if you were reviewing this report based on Appendix A requirements, and then read through Example B. Bold portions of Example B show the improveinents.

  1. ALLEGATION

Residential Support Staff (RSS) Rashad Greene reported that co-worker Tony Steward forcefully shoved individual Jesse Drew to the floor, causing Drew to strike his head against a chair. Greene reported that Steward also yelled at Drew, but was not sure what he said. Steward was attempting to make Drew pick up grapes that Drew had thrown on the floor. Drew would not pick up the grapes, instead throwing a grape at another individual. Drew then started stepping on the grapes. Finally, Drew stuck his finger in Steward’s face. Steward pushed Drew to the floor at that point. RSS Rachel O’Leary intervened and walked Drew back to his room. Nursing staff observed that Drew had redness and a small scratch on the side of his head upon examination following the incident. The redness soon faded away. YCBDD reported the incident to the Cumberland Police Department. CPD declined to conduct a criminal investigation since no significant injury resulted.

  1. DOCUMENTS REVIEWED
  2. ITS MUI Report 2010-092-0262
  3. Best Care Inc. UIR, J. Drew, 6/21/10, 1:30 PM (RSS R. Greene)
  4. Behavior Support Plan, Jesse Drew
  5. FINDINGS OF INVESTIGATION

Best Care Program Director Laurna Lawrence

On 6/22/10 at 9:00 AM I contacted Best Care Program Director Laurna Lawrence to initiate the investigation. Ms. Lawrence noted that Mr. Drew’s behavior was very unpredictable. He often became physically aggressive toward staff Ms. Lawrence was not present at the home when the incident occurred. She received a telephone call from Mr. Greene describing the incident. Ms. Lawrencenstructed Mr. Greene to fill out an incident report and placed PPI Steward on administrative leave pending the investigation.

Ms. Lawrence noted that Mr. Steward has been a good employee for Best Care over the past 2 years. Other staff often sought Steward’s assistance when Mr. Drew’s behavior got out of control. Lawrence felt Drew’s behavior support plan was ineffective in addressing his problem behaviors. She felt the gist of this incident was that Drew initiated aggression toward Steward. She did not believe Steward would intentionally harm Drew or any resident of the home.

Incident Reporter/RSS Rashad Greene

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