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									                                                                                   6709.12_30
                                                                                   Page 1 of 9




                                       FOREST SERVICE HANDBOOK
                                        KAIBAB NATIONAL FOREST
                                           WILLIAMS, ARIZONA



           FSH 6709.12 – SAFETY AND HEALTH PROGRAM HANDBOOK

            CHAPTER 30 – ACCIDENT INVESTIGATION AND REPORTING

Supplement No.: 6709.12-2002-1

Effective Date: August 27, 2002.

Duration: This supplement is effective until superseded or removed.

Approved: MICHAEL R. WILLIAMS                                  Date Approved: 08/27/2002
          Forest Supervisor

Posting Instructions: Supplements are numbered consecutively by Handbook number and
calendar year. Post by document; remove the entire document and replace it with this
supplement. Retain this transmittal as the first page(s) of this document. The last supplement to
this Handbook was 6709.12-98-1 to 30-35.

New Document                      6709.12_30                                               9 Pages

Superseded Document(s) by         6709.12_30-35                                            8 Pages
Issuance Number and               (Kaibab supplement 6709.12-98-1,
Effective Date                    dated October 2, 1998)

Digest:

32.1 – Identifies Kaibab National Forest accident notification criteria and process.

33 – Formally incorporates existing accident notification procedures on the Kaibab National
Forest into handbook and establishes Kaibab Forms 07-6700-01 (Notification of Accident or
Injury) and 07-6700-04 (Safety Incident Report).

34 – Establishes flow charts to assist in the accident/injury reporting process.

35.3 – Identifies specially trained Forest individuals to investigate accidents as documented in
the Kaibab National Forest Safety Plan.
KAIBAB NF SUPPLEMENT 6709.12-2002-1                                           6709.12_30
EFFECTIVE DATE: 08/26/2002                                                    Page 2 of 9
DURATION: This supplement is effective until superseded or removed.

                      FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                       CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING


Digest -- Continued:

36 - Provides Forest supplementation to national accident investigation procedures. The three
exhibits are provided to aid in following the proper reporting procedure. Establishes Kaibab
Form 07-6700-06 (Motor Vehicle/Property Damage Case Report Transmittal) and establishes
internal procedures for routing formal accident/incident case reports.

33.2 Exhibit 01 - Incorporates a flow chart outlining the process for reporting a Personal Injury
Accident as Exhibit 01.

33.2 Exhibit 02 - Incorporates a flow chart outlining the process for reporting a Motor Vehicle
Accident as Exhibit 02.

33.2 Exhibit 03 - Incorporates a flow chart outlining the process for reporting a Property
Damage Accident as Exhibit 03.
KAIBAB NF SUPPLEMENT 6709.12-2002-1                                                 6709.12_30
EFFECTIVE DATE: 08/26/2002                                                          Page 3 of 9
DURATION: This supplement is effective until superseded or removed.

                      FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                       CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING


  32 - ACCIDENT NOTIFICATION

  32.1 – Kaibab National Forest Notification Criteria And Process.

       1. All major work related accidents, injuries, or illnesses must be reported to the
  immediate supervisor, who will in turn notify the Unit Head (District Ranger/Forest Staff
  Officer). In case of minor accidents, injuries, or illnesses, report these incidents to the
  immediate supervisor or crew leader, at a minimum.

        2. When vehicle accidents or property damages exceed $1000 or personal injuries are
  severe, such as broken bones, serious illnesses, hospitalization, or fatality, additional
  notifications must be completed (Sec. 32.1, Exhibits 1-5). Procedures for making these
  notifications are as follows:

              a. The Kaibab Forest Dispatcher will be notified by radio or telephone.

              b. The Kaibab Dispatcher will notify the Forest Safety Officer (Forest Supervisor)
                 and notify the affected unit District Ranger and the Kaibab Safety & Health
                 Coordinator.

              c. If a serious injury is associated with any accident, the Kaibab Dispatcher will
                 contact the Zone Compensation Officer in Human Resources.

              d. The Kaibab Dispatcher will first attempt to contact one of the above Forest
                 individuals. If successful, that individual will make the Region and/or Chief
                 notifications. If unsuccessful, the Kaibab Duty Officer will be contacted and
                 will notify the Region or Chief’s Office. Refer to FSH 6709.12, Sections 32.1,
                 32.2, and Accident Investigation & Reporting Guide (April 2000).

   REGION 3 CONTACTS ARE:
                                                           OFFICE PHONE     CELLULAR PHONE
   Safety & Occupational Health
   Manager                                                   505-842-3393       505-301-1294
   (James Rawlinson)
   Regional Aviation Safety Officer
                                                             505-842-3351       505-450-8504
   (Larry Hindman)

   WASHINGTON OFFICE CONTACTS ARE:
                                     OFFICE PHONE                           PAGER
   Human Resources - Health & Safety 703-235-8102                           800-759-7243
   Program Coordinator               ext. 3135                              (pin 805*6118)
   (Ronald Wilson)
KAIBAB NF SUPPLEMENT 6709.12-2002-1                                              6709.12_30
EFFECTIVE DATE: 08/26/2002                                                       Page 4 of 9
DURATION: This supplement is effective until superseded or removed.

                      FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                       CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING


  33 – ACCIDENT REPORTING

  33.1 – Kaibab National Forest Accident/Incident Notification Process. All work related
  vehicle and property accidents, personal injuries and illnesses must be reported to the
  immediate supervisor and the immediate supervisor will in turn notify the District Ranger
  and/or Forest Supervisor. Minor personal injuries need only be reported to the immediate
  supervisor or crew leader. These individuals may use discretion of upward notification,
  however, if there is any doubt, notify next higher-level manager. However, one of the
  following Kaibab Forms; 07-6700-01 (Notification of Accident or Injury) or 07-6700-04
  (Safety Incident Report) will be utilized on the Kaibab National Forest to report all work
  related accidents, property damage, injuries, or illnesses.

         1. Kaibab Form 07-6700-01, (Notification of Accident or Injury), will be used to report
         vehicle accidents and/or property damages exceeding $350 damage or a personal injury
         requiring medical treatment. Supervisor or designee must make e-mail notification
         within 2 days to the "pdl r3 kaibab accidents" mailing list (sec. 32.1). The ―pdl r3
         kaibab accidents‖ e-mail mailing list includes the Forest Supervisor, Kaibab District
         Rangers, Forest Safety & Health Coordinator, Administrative Officer, Hazard Materials
         Coordinator, Financial Officer, Personnel Officer, Law Enforcement Officer, and
         Forest Safety Committee members.

         2. Kaibab Form 07-6700-04, (Safety Incident Report) will be used to report vehicle
         accidents or property damage less than $350, or a minor personal injury or a first aid
         injury not requiring medical treatment, or to report a ―near miss‖ situation, such as
         detecting a hazardous situation or event, a procedure, or equipment dysfunction that
         resulted in a near miss accident. Either make an e-mail notification or send a hard copy
         to the Kaibab Forest Safety & Health Coordinator.


  34 – ACCIDENT INVESTIGATIONS

  All work related accidents, regardless of severity, require some degree of investigation. The
  Unit Manager (District Ranger or Staff Officer) is responsible for assuring that all accidents are
  properly investigated, all necessary forms and reports are completed, and that forms and
  reports are transmitted as stated below in Section 36. As a minimum, a memo documenting the
  investigation should be submitted with forms specified in flow charts, Section 33.2, Exhibits
  01-03.
  The flow charts contained in Section 33.2, Exhibits 01, 02, and 03 are designed to provide
  guidance in the procedures for notification, investigation, and reporting of accidents.
              1. Exhibit 01 is for personal injury accidents and occupational illnesses,
              2. Exhibit 02 is for motor vehicle accidents, and
              3. Exhibit 3 is for property damage incidents/accidents.
KAIBAB NF SUPPLEMENT 6709.12-2002-1                                              6709.12_30
EFFECTIVE DATE: 08/26/2002                                                       Page 5 of 9
DURATION: This supplement is effective until superseded or removed.

                      FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                       CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING


  The exhibits are not mutually exclusive. Often, an accident involves personal injury, property
  damage, and motor vehicles. In such a case, the procedures of all three exhibits are applicable.
  Proper use of the exhibits requires that all three be reviewed and that any applicable paths
  identified be followed until all procedures have been completed. All formal reports will be
  mailed to the Personnel Officer, who will insure that reports are properly completed.

  For minor accident investigation, the unit manager may delegate these responsibilities on a
  case-by-case basis, however, for very severe accidents, the unit manager should immediately
  begin an investigation and continue until the responsibility for accident investigation and
  reporting is taken over by higher organizational levels.


  35 – INVESTIGATION PROCEDURES

  35.3 – Team Composition. Individuals specifically trained to investigate accidents on the
  Kaibab National Forest shall be listed in the Kaibab National Forest Safety Plan. Those
  individuals and the affected unit’s first-level line officer shall immediately begin an
  investigation and continue until the responsibility for investigation and reporting is assumed by
  higher organizational levels.

  For minor injury, illness, or property damage accidents, a single investigator may often suffice.
  This may be the first line supervisor or delegated to the next lower level manager or a
  supervisor position.


  36 – FOREST SERVICE ACCIDENT INVESTIGATION REPORTS

  The Kaibab National Forest will utilize Kaibab Form 07-6700-06 (Kaibab NF Motor
  Vehicle/Property Damage Case Report Transmittal) for internal distribution for motor
  vehicle/property damage case reports. The following individuals will review case reports:

       1. Safety & Health Coordinator - Reviews case report.
       2. Fleet Equipment Manager - Reviews motor vehicle accident reports.
       3. Road System Manager - Reviews accidents on Forest roads.
       4. Property Management Officer - Determines negligence (coordinates with Fleet
          Equipment Manager, Health and Safety Coordinator, and others as necessary) and
          indicates decision on AD-112.
       5. Administrative Officer – Makes determination on financial liability.
KAIBAB NF SUPPLEMENT 6709.12-2002-1                                           6709.12_30
EFFECTIVE DATE: 08/26/2002                                                    Page 6 of 9
DURATION: This supplement is effective until superseded or removed.

                      FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                       CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING



       6. Personnel Officer - Reviews Property Management Officer's determination and follows
          up with Forest Supervisor on disciplinary action/financial responsibility.
       7. Budget & Finance Officer - Makes copy for claim file as needed, indicates action taken
          on AD-112.
       8. Personnel Section Representative - Receives Case File for filing and sends a copy of
          the completed case to RO-HR; returns copy of AD-112 to submitting unit; and posts
          closure to Accident Report Log.
            KAIBAB NF SUPPLEMENT 6709.12-2002-1                                                                                                                              6709.12_30
            EFFECTIVE DATE: 02/02/2002                                                                                                                                       Page 7 of 9
            DURATION: This supplement is effective until superseded or removed.

                                            FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                                             CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING

                                          33.2 – Exhibit 01 - Flow Chart for Personal Injury Accidents

                       Responsible Officer
                       Determines initial
                       Level of investigation                                                       IBM Notification




                                                                                                                                                                                 Fatal
Notify Forest          See                                                                                   Who
                                            Fatal or        Severity                 Employee                                             Private                         Severity
Supervisor             FSH 6709.12                                                                         Involved
Immediately            Ch. 32.1                                                                               ?
                                            Severe

                                                                       Other                                                                                                             Other

                                                                                     Occupational
                                                            Complete                                                                                                                                    FS-6700-8 Report
                                                                                     Illness CA-2
                                                           Appropriate                                                                                                     Claim                       of Incident to Other
                                                           Notification                                                                                                   Potential                     Than Employees
                                                                                                                                                                                                 Low



                                                       Investigation Report

                                                                       Traumatic                                                                                                     High
                                                                       Injury CA-1


                    CA-1                    NO                Dr.                                      Complete CA-2
                 To Personnel                                Needed                                    & Appropriate                                                     FS-6700-8
                                                               ?                                        Checklist for                                                 Invest. Report per
                                                                                                       Determination                                                    FSH 6709.12
                                                                       YES                              By OWCP *


                 APMC Case
                 FS 6100-16                                    Lost
                   Send to                 NO
                                                               Time
                Program Phys.                                                                                         *Initial doctor visits are the employees responsibility,
                                                                 ?
                                                                                                                      until such time as OWCP makes a ruling in the case.

                                                                       YES


                                                          OWCP Case
                      More                                  CA-16
                                                YES
                than follow-up                              CA-17
                  visit needed                            OWCP-1500


                            NO
                                                          Send all paperwork
                                                            To Personnel
          KAIBAB NF SUPPLEMENT 6709.12-2002-1                                                                                        6709.12_30
          EFFECTIVE DATE: 02/02/2002                                                                                                 Page 8 of 9
          DURATION: This supplement is effective until superseded or removed.

                                            FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                                             CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING

                                                                          33.2 – Exhibit 02
                                                              Flow Chart for Motor Vehicles Accidents

                                                                                                  MOTOR
                                                                                                  VEHICLE
                                                                                                 ACCIDENTS
                                      Responsible Officer
                                       Determines initial
                                     Level of investigation


                                                                                                  IBM Notification




                                                                                                    Vehicles                                                FS-6700-8 Report of
                                                    NO            Appearance       Govt.                             Private                          Low
                                                                                                    Involved                        Claim                    Incident to Other
                                                                 Of Negligence?
                                                                                                                                   Potential                 Than Employees




                                                                             YES                                                               High



 SF-91                        Fleet Manager’s                     Investigation
         >$350.00                                                                                                                 FS-6700-8
AD-112                        Damage Estimate                        Team
                                                                                                                               Invest. Report per
                                                                                                                                 FSH 6709.12




                                         <$350.00
                                                                  Investigation
                                                                     Report

                    SF-91 – Operator’s Report
                    SF- 91A-- Investigation Report of MVA
                    SF-94 – Statement of Witness
                    AD-112—Report of Damaged Property                                      Send all paperwork to
                                                                                               Personnel &
                                                                                             Attn: Health and
                                                                                            Safety Coordinator
        KAIBAB NF SUPPLEMENT 6709.12-2002-1                                                                                6709.12_30
        EFFECTIVE DATE: 02/02/2002                                                                                         Page 9 of 9
        DURATION: This supplement is effective until superseded or removed.

                                  FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
                                   CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING

                                                         33.2 – Exhibit 03
                                                  Flow Chart for Property Damage


                                                                      PROPERTY
                                                                       DAMAGE

     Responsible Officer
     Determines initial
     Level of investigation


                                                                    IBM Notification




                                                       Govt.            Property           Private                        Low        FS-6700-8 Report of
         Appearance                                                                                       Claim
NO                                      AD-112                         Ownership                                                      Incident to Other
       For negligence?                                                                                   Potential
                                                                           ?                                                          Than Employees
           Severe?



                                                                                                                 High

        YES                                                                    Employee


                                                                                                        FS-6700-8
                                                                 AD-358 Employee Claim               Invest. Report per
                                                                  Supervisor’s Statement               FSH 6709.12
        Investigation
                                                                    Witness Statement
           Report




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