In order to do this the first step is to gather information to determine the chain of events leading up to the accident/incident; the root causes of the accident/incident and any contributory factors that affected the scale of the consequences and; the remedial actions necessary to prevent a recurrence.
Leoborah Risk Solutions can assist in undertaking any investigation and formulating (and instigating) plans to prevent recurrence. We would be delighted to discuss your specific requirements.