• Jo De Landre


In May 2016 I published an article on LinkedIn in relation to the contents of Incident Investigation Reports. This article compliments that one and provides general advice about writing style.

Collecting the data during an incident investigation is just one part of the investigation task. At the end of the day, all of that data has to be validated, sorted, analysed and a report produced. I often say that there are three primary attributes an Investigator needs:

  • They need to have the skills and expertise to investigate

  • They need to have great liaison skills, working and interviewing many personnel from the newest person at the site, through to the CEO sometimes; and

  • They need to be able to organise data and write a report.

It is at the report reporting phase that I often get calls from people, who ask for my help. When I conduct quality reviews of reports, I often find that the text just doesn’t flow and it doesn’t tell the story from the beginning through to the end. The Investigator has lived and breathed that incident and could verbally answer any questions, yet often struggles to convey in a succinct fashion the relevant data for the report. Here’s some tips on writing style that should help when preparing an investigation report:


There are generally three types of investigation reports:

  • Interim notification of safety actions. If a safety action requires immediate attention as soon as it is identified, i.e., it cannot wait until the final reporting stage, it shall be drawn to the attention of the organisation concerned without delay; this may be as simple as a single-page memorandum.

  • Preliminary draft report. A preliminary draft report may be prepared by the investigator and circulated for comment to the responsible manager or authority and as otherwise required by the terms of reference. This is generally restricted to matters of fact.

  • Final report - After any appropriate amendments to the draft report, the final report should be submitted to the manager or responsible authority.

NOTE - The focus of these notes will be on the format of the final report.


The most important feature of a good investigation report is that it is easy to read by everyone likely to read it. That doesn’t mean tailoring the report to the lowest common denominator, but it does mean organising the report in a way that enables readers with different needs to negotiate their way through the report and get easy access to the information each reader needs. Other important features are that the report is:

  • Clear;

  • Concise;

  • Accurate; and

  • Probative (furnishing evidence or proof).


  • Write Professionally, but Not Pompously - The report you are writing won’t just be read by people within your department or your field. Don’t assume that everyone will understand certain things you write in the report, because it will only serve to confuse the readers and will damage your credibility. Keep the high-level vocabulary to a minimum and refrain from use of jargon.

  • Write Concisely - The more one writes reports, the easier it will become to spill the words out and get it right after a few tries. A good report will consist of thorough, detailed information but will also be fairly brief and to the point.

  • Tells a Story - A well-written report “tells a story.” The report should answer these questions about the incident; who, what, when, where, why, and how. It should also state the facts clearly, accurately, and completely. Also include mitigating circumstances and facts that do not support your conclusions to ensure you tell the “whole” story, not just one side.

  • Stands Alone - A report must “stand alone” and provide sufficient information without referring to exhibits or other documents.

  • Clear and Logical. Any reader, even someone who has no knowledge of the incident should understand how you reached your conclusions based solely on the report.

When writing the report:

  • Use direct, clear, and concise language.

  • Present the information in a logical progression, from facts to conclusions, stated in precise and neutral terms.

  • Explain your reasoning. You must convince the reader that your conclusions are supported by the facts and analysis in your report.

  • Distinguish between facts, assumptions, conclusions, and opinions.

  • Proper Style and Tone - Most reports convey some degree of bad news. It is not only what you say, but also how you say it that contributes to a “good” report. Use the proper style and tone to explain why you did or did not substantiate a finding so the reader can more easily accept the conclusions.

  • Avoid emotional, judgmental or value-laden words to describe events.

  • Use active voice to let the reader know who performed the action.

  • Concentrate on using the correct format

  • Use plain language - Every day spoken language makes it more likely readers of the report will understand the outcome of the investigation and the reasoning that supports any recommendations. In direct speech, we generally use an active voice rather a passive voice. Using an active voice and direct verbs, not nouns, makes the report ‘speak’ to the reader and easier to read.

  • Example of passive and active voice. Passive: “the person was interviewed…” Active: “Investigators interviewed the person…”

  • A good test of whether a report is easy to read will be how easy it is to read aloud and whether a person listening to the report being read out aloud can understand what is being said. Where a report is likely to have a broad ranging audience it is particularly important to ensure technical terms are explained in everyday language. It is also important to avoid jargon or acronyms that are exclusive to particular industries or sectors.


  • Is the report easy to read?

  • Does it use plain, everyday language?

  • Is it well laid out? Do the sub-headings summarise the content? Do they follow a logical sequence?

  • Is all of the material probative? Does it provide adequate evidence from multiple sources to confirm key findings?

  • Is the information in the report accurate? Will the reader be clear about what the established facts are? Will the reader be able to distinguish what is your opinion or conjecture?

  • Is the evidence clearly set out to support the conclusions and recommendations?

  • Does the report accurately reflect the quality of your investigation?

Interested in Knowing More?

Further information on Safety Wise’s Incident Cause Analysis (ICAM) Training is available from our website:

Additional ICAM Related Services

Safety Wise also offers the following additional services for sites that adopt the ICAM investigation analysis method:

  • Quality review of incident investigations using ICAM

  • Trend analysis of organisational factors contributing to serious incidents

  • Participation in investigations as an external / independent party

ABOUT THE AUTHOR- Jo De Landre (Chief Operations Officer)

After 15 years with the Bureau of Air Safety Investigation (BASI),which became part of the multi-modal Australian Transport Safety Bureau (ATSB), Jo started co-facilitating ICAM training with Safety Wise in 2001 as the Principal Human Factors Consultant.

In 2005, Jo was promoted to the position of Executive General Manager of Safety Wise and beyond providing human factors specialist services and ICAM training and Investigations, she is now involved in strategic activities such as project management and developing safety management programs.

Jo has been the Safety Wise Lead Investigator for many high profile accidents, including multiple fatality investigations. She has a Bachelor’s Degree in Applied Psychology and a Graduate Diploma of Psychology, and has published papers in aviation, mining and police journals and publications.

Joanne has also been Secretary of the Australian Aviation Psychology Association (AAvPA) for close to a decade.

#investigator #Nurture #assist #fatality



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