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Tips and Tricks to a Proper Accident Investigation
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Tips and Tricks to a Proper Accident Investigation
Zach Pucillo
CSP, E&S Engineer
Questions
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Overview
-Initial Notification
-Investigating the Scene
-Initial Documentation
-Accident Analysis
-Prioritize Risk
-Prevention Implementation
-Final Documentation
Scenario
An employee has just come to your office stating that Technician Joe has just slipped and fell in the detail department. He landed square on his back and is unable to get up.
INITIAL NOTIFICATION
Initial Notification
Accidents must be reported as soon as they happen, so how can you work to make this happen?
-Make sure that employees understand the potential consequences of not reporting accidents
-Work with your insurance company
-Workers comp claims can be a lengthy process due to suspicions
Initial Notification
-First aid vs 911
-Inform the accident investigator
-Grab a camera, notebook, and pen
-Head out to the accident scene
-Eliminate dangerous conditions in the area
INVESTIGATING THE SCENE
Investigating the Scene
Once You Get There
-Do not start any cleanup of the scene
-Determine the witnesses
-Separate them
-Instruct them to write down their account
-Take pictures of the area where the accident happened
-Take note of any equipment used, the condition of the floor, PPE in use, was the employee in a hurry…
Investigating the Scene
-Make documented observations on:– Pre-accident conditions– Accident sequence– Post-accident conditions
-Document the facts (i.e.: location, witness remarks, and contributing factors).
-Determine sequence of events leading to accident
Investigating the Scene
-Use an accident/incident investigation form
-The first half will be the facts
-The middle will involve investigation analysis
-The end will state the prevention method to be implemented and follow up
Investigating the Scene
Conduct the Employee Interviews
-Interview one at a time
-Have the employee tell you a story
-Match their written notes with their story
-Establishes credibility
ACCIDENT ANALYSIS
Accident Analysis
Analysis Must be Done in a Safety Committee
-Group of employees representing each level of employment
-Eliminates Bias
-Ensures that Corrective Actions are Assigned
-Establishes Accountability
-Accountability is imperative for follow up
Accident Analysis
Root Cause Analysis
-Fishbone Diagram
-Fault Tree Analysis
-FMEA (Failure Mode and Effect Analysis)
-What-If
-HAZOP
-MORT (Management Oversight and Risk Tree)
-Job Safety Analysis
Accident Analysis
Root Cause Analysis
-First determine the main causes that contribute to accidents
-This is done using the Pareto Theory
-Vilfredo Pareto and the land in Italy
-Pareto theory is 80% of the accidents are caused by 20% of the possible causes
Accident Analysis
Accident Analysis
Find the Root Cause of the two main causes by using the fishbone diagram
-Employees cannot be the main cause
-Root causes are always contributed back to management oversight
Accident Analysis
Accident Analysis
Accident Analysis
5 Whys?
The vehicle will not start. (the problem)Why? - The battery is dead. (first why)Why? - The alternator is not functioning. (second why)Why? - The alternator belt has broken. (third why)Why? - The alternator belt was well beyond its useful
service life and not replaced. (fourth why)Why? - The vehicle was not maintained according to the
recommended service schedule. (fifth why, a root cause)Why? - Replacement parts are not available because of the
extreme age of the vehicle. (sixth why, optional footnote)
Accident Analysis
Joe slipped and fell in the detail departmentWhy? –Because he was not wearing slip resistant
shoes
Why? –Because he does not have any slip resistant shoes
Why?-Because he is not required to wear them in detail
Why? –Because management does not have a policy on slip resistant shoes in detail
Why? –Because management has not identified slipping as a hazard in the detail department
Accident Analysis
Fault Tree Analysis
-Deductive reasoning or top down event structure
-Helps to identify all possible causes in a system or procedure
-Can be used with boolean algebra to determine the probabilities of an event occurring
-Best used in the new design of equipment of procedure
Accident Analysis
Accident Analysis
Prioritize Risk
Hazard Control Priorities
-Eliminate the Hazard
-Reduce the Hazard Level
-Provide Safety Devices
-Provide Warnings
-Provide Safety Procedures and PPE
Prioritize Risk
Risk Management
-Risk Identification
-Risk Analysis
-Eliminating or Reducing the Risk
-Financing the Risk
-Administering the Risk Management Process
WHAT IS AN ACCEPTABLE LEVEL OF RISK?
Prioritize Risk
Risk Assesment Matrix
Prioritize Risk
-Complacency
-Doing the same job over and over
-Driving example
-Rushing to get a job done
-5:00pm is approaching
-Cutting corners to be more productive
Prevention Implementation
-Positive incentive programs are not good
-Peer pressure
-Employee demotivation
-Signage
-Orange dot program
-Safety committee involvement
-Invest money saved into the facility
-Stay away from “If you go…then you get”
Prevention Implementation
-Department walk throughs
-Let employees pick the PPE
-Personal Signage
Prevention Implementation
Prevention Implementation
Anti Fog Bifocal Safety Glasses Goggle Type Glasses
Prescription Safety Glasses Glasses that fit over Prescripts
Prevention Implementation
Auto Darkening Welding HelmetOperation ProtectorsTypical Lens Shade
Electric ArcWelding Helmet 10 to 14
GasWelding Goggle, Faceshield, Helmet 4 to 8
CuttingWelding Goggle, Faceshield, Helmet 3 to 6
Torch BrazingWelding Goggle, Faceshield, Helmet 3 to 4
Torch Soldering Welding Spectacles, Faceshield 1.5 to 3
Prevention Implementation
Electric Tire Lifting
Machines
Prevention Implementation
Improvements in Hand Protection
Prevention Implementation
Good Better Best
Prevention Implementation
Slip Resistance
Prevention Implementation
Hearing Protection Noise Reduction Ratings
= 91dB
dB 120
+ = 64dB
Final Documentation
Complete the accident investigation form
-Prevention Method
-Assigned Action Items
-Method to Measure the Effectiveness
-Evaluate
Final Documentation
OSHA 300 Forms
Notice of Proposed Rulemaking
New North American Industry Classification System (NAICS) Codes
4411 Automobile Dealers
4413 Automotive Parts, Accessories, and Tire Stores
Employers to report to OSHA, within eight hours, all work-related in-patient hospitalizations
Final Documentation
OSHA 300 Log
Final Documentation
What is recordable?
Final Documentation
This Summary Must be Posted from 2/1 to 4/30 Each Year
Final Documentation
The following examples are not recordable:
-Present as a member of the general public-Symptoms arising in work environment that are solely due to non-work-related event-Voluntary participation in wellness program-Eating, drinking or preparing food or drink for personal consumption
Final Documentation
-Personal tasks outside assigned working hours-Personal grooming, self medication for non-work-related condition, or intentionally self-inflicted-Motor vehicle accident in parking lot/access road during commute-Common cold or flu-Mental illness, unless employee voluntarily provides a medical opinion from a physician or licensed health care professional (PLHCP) having appropriate qualifications and experience that affirms work-relatedness
Final Documentation
Common OSHA 300 Questions Answered-Do not include the day of injury/illness-Count the number of calendar days the employee was unable to work (include weekend days, holidays, vacation days, etc.)-Cap day count at 180 days away and/or days restricted-May stop day count if employee leaves company for a reason unrelated to the injury or illness-If a medical opinion exists, employer must follow that opinion-Privacy cases do not require name
Summary
Investigating an Accident is a Procedure
Document
Put in the Time to Investigate
Analyze for Remedies
Prioritize Risk
Implement
Document
Evaluate
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