Practice Name Accident Reporting and Investigation Program Accident Reporting and Investigation Program Date: Approved By: Position: Date: PURPOSE To ensure that all accidents, injuries and near misses are reported immediately and investigated to the fullest extent possible. Effective implementation of this policy will address our employees medical needs, identify corrective actions, and prevent recurrence. SCOPE Practice Name Accident Reporting and Investigation Program applies to all of Practice Name employees and visitors. DEFINITIONS Accident: an unplanned or uncontrolled event that led to or could have led to injury, property damage, impairment to the environment, or other loss. Accident Investigation: a fact-finding procedure that reveals facts that are used to prevent recurrences of similar accidents. Hazard: an unintentional event that has the potential to cause damage to people, property, and/or the environment. Near Miss: a near miss is an unplanned event that did not result in injury, illness, or damage but had the potential to do so. Loss: the injury, death, financial or property damage arising from an accident. Unsafe Condition: a physical condition within the environment that has the potential to cause or contribute to an accident. Unsafe Act: a violation of the accepted standard practices with the potential to cause or contribute to an accident. Accident Reporting and Investigation Program Page 1 Practice Name RESPONSIBILITIES Human Resources Provide necessary care for injured employee or occupant of facility. Complete Employers First Report of Injury and submit to insurance carrier within 24 hours of the injury. Ensure that all accidents are investigated as soon as possible but no more than 24 hours after the event. Ensure that corrective actions are developed and implemented. Ensure that Accident Investigation Reports are kept on file for future reference. Review accident investigation report forms to ensure that all pertinent information has been included. Provide training for employees on safe work procedures and accident reporting. Complete necessary paperwork to report to the workers’ compensation carrier when applicable. Arrange for post accident drug and alcohol testing. Employees Report accidents, injuries, and illnesses to their supervisors immediately. Report unsafe acts, conditions, or near miss incidents to their supervisors as soon as possible. Be cooperative, truthful and assist during all accident investigations. Supervisors Ensure that employee is treated immediately following an accident or incident as appropriate. Ensure that injured employee is transported to a Practice Name –approved occupational health care facility or medical provider. Submit completed Accident Investigation Report to Human Resources within 24 hours of an accident. Assist in identifying corrective actions to be taken to prevent reoccurrence. TRAINING With the exception of the injured employee, who may or may not have received previous training, every employee conducting accident investigations should be trained in accident and incident investigation and identifying root causes prior to being assigned to an investigation team. The Human Resources Manager (or other employee designated by Practice Name for maintaining training records) will maintain a list of employees trained in accident and incident investigation and root cause analysis as well as the training records/dates of training sessions Accident Reporting and Investigation Program Page 2 Practice Name ACCIDENT/INCIDENT REPORTING Practice Name requires that all workplace accidents or near misses be reported immediately by the employee to their immediate supervisor. The supervisor/employee will complete the Accident Investigation Report within 24 hours of the accident or, in the event of a serious injury, when they are physically able. Employees who do not report an accident or incident to their supervisor before leaving work the day of the accident or incident may be subject to disciplinary actions. MEDICAL EVALUATION AND TREATMENT The injured employee will be evaluated by someone trained in 1st aid and 1st aid will be administered immediately. In the event of a serious injury, call 911 for ambulance/paramedic assistance. Injured employees requiring treatment beyond 1st aid but not deemed to be serious will be transported to the following facility by a designated person trained in 1st aid: Occupation Medicine Clinic Clinic: Address Phone # INVESTIGATION TEAM The supervisor, injured/involved employee, and (if applicable) the safety committee representative form the investigation team. The Practice Manager and others (as needed) may be asked to participate in the investigation at the team’s discretion. The team is responsible for completing the investigation and reporting their findings on the Accident Investigation Report. The supervisor leading the investigation team should submit a signed copy of the Accident Investigation Report to the Human Resources Manager of the facility as a permanent record. INVESTIGATION PROCEDURES The main objective for an accident investigation is to identify the root cause(s) of the accident and develop the corrective actions to prevent the reoccurrence of the accident. Investigations should be investigated as soon as possible after they occur so that facts are fresh in everyone’s mind. The contributing factors of an accident may be obvious and be determined immediately with relative ease. However, it is important to determine the underlying or root causes of an accident. The steps taken to conduct an accident investigation in order to reach our objective are: Provide medical attention to injured party Remove or isolate the hazard at the scene Assemble investigation team Accident Reporting and Investigation Program Page 3 Practice Name Preserve the scene Observe conditions / take pictures Interview witnesses Review records Perform root cause analysis Communicate the investigation results Take corrective action to prevent reoccurrence Document findings and corrective actions taken ACCIDENT EVALUATION Evaluation of the accident will begin after the initial data is gathered and is intended to identify contributing factors and root causes of the accident. The root cause analysis should be conducted according to the steps identified in Appendix C. CONDUCTING INTERVIEWS Injured employees, witnesses and any other employees familiar with the accident or incident should be interviewed. The purpose of the interview is to gather information regarding the accident or incident, not to assign blame. Identify each witness – name, occupation, years of experience, etc. Conduct in a quiet and private location Get statements as soon as possible Do not provide any facts or opinions to the witness Explain the purpose of the investigation and put the witness at ease Listen, let each witness speak freely, and be professional, courteous, and considerate Take notes without distracting the witness. Use a tape recorder only with the consent of the witness and have the witness complete and sign an authorization form Use sketches and diagrams to help the witness Emphasize areas of direct observation Do not argue with the witness Record the exact words used by the witness to describe each observation WRITTEN REPORT Following an investigation and analysis, a summary report should be prepared, including the recommended actions to prevent reoccurrence. Report details will consist of but are not limited to the following: Date, Time, Location Injured Witnesses (Name, Address, Phone Number, etc) Treating Physicians (Name, Address, Phone Number, etc) Activities just prior to accident or incident Accident description – sequence of events Accident results Accident Reporting and Investigation Program Page 4 Practice Name Description of any machinery involved Witness statements Diagrams and photos Immediate temporary corrective actions Recommended longer term corrective actions The investigation team must assign a person responsible and target date for each corrective action recommendation from the investigation. The persons assigned to perform the corrective actions do not have to be from the team. All recommendations will be tracked to completion by the investigation team. PROGRAM EVALUATION The accident investigation / reporting program will be reviewed annually by the Safety Committee and Human Resources. The revisions at the time of review will be recorded and noted on the next revised version of the policy. APPENDICES A. Employer’s First Report of Injury B. Accident Investigation Form C. Identifying Root Causes Revision Date Description of Revision Approved By: Accident Reporting and Investigation Program Page 5 Practice Name Appendix A Employer’s First Report of Injury (Insert State-Required Form) Practice Name Appendix B Accident Investigation Report Practice Name Accident Investigation Form Location State Dept Phone Employee Name DOB Employee # Address City State Zip SS# Married Yes No Sex Male Female Job Title Hire Date Employee Description of Incident: Employee Signature Incident Details Date of Incident Time of Incident AM PM Date Reported Incident Location (area) On Employer Premise Yes No Witness(es) Employee lost time to injury Yes No First Aid Given Yes No Date Worker Left Work Time Worker Left Work Date Worker Returned Medical Facility Doctor Follow Up Appointment Scheduled Yes No Time Off Authorized by Physician Yes No If Yes, How Many Days Treatment Given Prescription Irrigation Sutures Tetanus Shot Brace Cast Remove Foreign None Ace Bandage Other: Practice Name Part of Body Injured Head Arm R L Trunk R L Hip R L Foot R L Face Elbow R L Shoulder R L Thigh R L Toe R L Eye RL Forearm R L Chest R L Knee R L Ribs R L Nose Hand R L Back R L Leg R L Skin R L Neck Finger R L Abdomen R L Ankle R L Other R L Other: Nature of Injury (mark all that apply) Abrasion Puncture Chemical Inhalation Burn Bruise-Crushed Fracture Hearing Fatality Other Laceration Poisoning Sprain Heat/Cold Amputation Dermatitis Strain Foreign Object Other: Investigation Supervisor Date of Investigation Investigator Name Employee’s Supervisor Supervisor’s Phone Who was immediately in charge at time of injury? Employee task trained? Yes No Yes, explain: Equipment Involved Type Model Mfg. Cause of Injury – (mark all that apply) Body Motions Hot/Cold Flame/Smoke Ladders Slip/Trip/Fall Bldg/Structure Conveyors Furniture Machines Flying Object Chemicals Electrical –HV Hand Tool Notices Flash Vehicles Electrical - LV Hoisting Particles Other Falling Objects Other: Practice Name Cause of Incident – (mark all that apply) Material Poor Equipment Excessive Speed Horseplay Handling Housekeeping Lack of Procedure Housekeeping Slippery Surface Fatigue Other Attention Failure Other: Root Cause Analysis Description of Incident: Steps Taken to Prevent Similar Occurrence Reinstruction of Employee Formal Disciplinary Action Reminder Instruction to All Employees Installation of Guard Device Personal Protective Equipment Required Counseling of Employee Explain: Supervisor Signature: Date: Send report to: Practice Name Appendix C Identifying Root Causes Practice Name Identifying Root Causes Identifying the root cause of an incident is one of the most important aspects of incident investigation. The root cause of an incident is the primary event without which the incident would not have happened. Another way to think of a root cause is: If the root cause had been prevented, the incident would not have happened. It is not always possible to identify the root cause of an incident, but we can usually get very close by analyzing the contributing or causal factors. Whether an incident is due to operations or maintenance problems, technical problems, industrial hygiene concerns, reliability concerns, natural phenomenon or sabotage, there are many ways to analyze the causes and categorize the root causes. Listed below are some root cause categories commonly used: - Equipment - Was a hazardous condition a contributing factor? Examples of hazardous conditions include: missing or defective equipment/parts, equipment/parts not inspected or deficiencies not reported properly, incorrect or improperly designed materials, tools, or equipment used, etc. - Communications - Were communications given in an understandable manner? In a timely manner? Fully understood by the receiver? - Environment/Ergonomic - Was the location or position of equipment, materials, or employees a contributing factor? Examples include: illumination, noise levels, air contaminants, temperature extremes, ventilation, vibration, radiation, weather, location/position/layout of equipment, position of employee, barriers/ warning lights and signs, etc. - Job Oversight & Supervision - Were the job and the workers selected, prepared and supervised properly? - Management System - Was a management system defect a contributing factor? Examples include: failure to detect, anticipate or report hazardous conditions, lack of or inadequate standards or policies, lack of auditing or communications with employees, etc. - Procedures - Were written, up-to-date job procedures in place and used properly? Examples include: missing or inadequate written procedures, sequence wrong, etc. - Training -Was adequate training conducted and fully understood by employees? Practice Name The incident investigation team first determines the sequence of events in the incident. Then the team identifies the potential causes and the root cause, if possible. Lastly, the team makes recommendations to prevent reoccurrence and documents their results. The questions on the next few pages are designed to help the team systematically analyze the incident and identify the root cause. Practice Name Identifying Root Cause “No” answers should be considered as causal factors and a potential root cause(s). Yes No Part 1 - Equipment 1. Was there no failure of the equipment involved in the incident? (If yes, go on to Part 2) 2. Was equipment maintained in a safe and operable condition? 3. Was there a written maintenance schedule for the equipment? 4. Was the maintenance schedule followed? 5. Was this a repeat failure of the equipment? (If yes, go to Management Systems) 6. Was the equipment designed and reviewed according to written procedures? 7. Did the specifications address the means by which the equipment failed? 8. Was the equipment or parts defective? (If yes, determine if the root cause exists in how the equipment was obtained, manufactured, handled, stored, or tested prior to use.) 9. Was this an expected failure? Part 2 – Communications 1. Were communications adequate? (If yes, continue to Part 3) 2. Were communications timely? 3. Were communications clear, fully understood by recipient, the right length, not confusing, communicated in area/location where they could be fully understood? Part 3 - Environmental/Ergonomic 1. Were environmental or ergonomic factors adequate? (If yes, continue to Part 4) 2. Were the following conditions adequate: labeling, the arrangement or placement of the machine and employee, instruments, displays, warning lights, the awareness of the operator, duplicate machines/equipment the same? 3. Was housekeeping good, the work environment a comfortable temperature, good lighting, acceptable noise level, not cramped/crowded, Practice Name Yes No no other contaminants or health hazards? 4. If the operating system is complex did the operator possess the knowledge he or she needed to operate safely and was the operator monitoring no more than 3 critical functions at once? 5. In the operating system were errors detectable by the operator and could he or she adequately recover from errors? Part 4 - Job Oversight and Supervision 1. Were job oversight and supervision adequate? (If yes, continue to Part 5) 2. Was there a good, understandable work package? Adequate job preparation? Pre-job briefing and walk-through? Lockout performed? Job scheduled appropriately? 3. Was the worker qualified to perform the task? 4. Was the worker in good physical and mental condition to perform the task? (Not tired, upset, under the influence of drugs or alcohol) 5. Was there adequate supervision during the work? Part 5 - Management System 1. Were management systems (standards, policies, work rules, audits and evaluations, corrective actions taken as necessary) adequate? (If yes, continue to Part 6) 2. Were written standards available in the work place? Fully communicated to employees? Clear and complete? Technically accurate? Enforced uniformly? 3. Were audits and evaluations conducted per specified frequencies? 4. Were audits and evaluations detailed enough to detect deficiencies and conducted by an objective person? 5. If corrective action had already been specified but not yet implemented, were the reasons/time frames for delay reasonable? Practice Name Yes No Part 6 – Procedures 1. Were written procedures present and followed correctly? (If yes, continue to Part 7) 2. Was the procedure available and convenient to use? 3. Was the procedure followed correctly? 4. Was the format clear? Less than one action per step? Graphics clear? Computations/specifications clear? Checklist clear? Equipment identification clear? 5. Was the procedure free of typographical errors? Facts correct? All potential situations covered? The correct version of procedure used? Part 7 – Training 1. Was training and employee understanding of training adequate? (If yes, go back and identify the root cause and corrective actions for each ?no? answer.) 2. If there had been a decision not to conduct training, had the task been analyzed? 3. Did the lesson plan address the situation which led to the incident? 4. Was there adequate practice and testing to ensure the employee understood the training? 5. Was there adequate continuing education to ensure the employee continued to be able to do the job safely?
Pages to are hidden for
"Accident Investigation / Reporting Policy"Please download to view full document