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Accident Investigation Page 1
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Accident InvestigationCourse Outcome Summary
InformationProject Title Accident Investigation
Course Number 10-449-103
Credits 3
Potential Hours 54
Development Date 09/20/2004
Types of Instruction
Type of Instruction Contact Hours Outside Hours CreditsClassroom Presentation 54 0 3
Totals 54 3
DescriptionIn this course !ou "ill determine cause uncover indirect accident causes #revent similar accidents $rom
occurring document $acts #rovide in$ormation on costs and #romote sa$et!%
Core Abilitieso &emonstrate ada#tation to change%
o 'se critical and creative thin(ing to solve #ro)lems resolve con$licts ma(e decisions and
com#lete tas(s%
o *or( coo#erativel! in a team environment%
o Communicate in "a!s that honor diversit!%
o &emonstrate #ersonal integrit! through ethical and res#onsi)le )ehaviors%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan 1
Benefits of Work Injury/IllnessAnalysis
Overview A s!stematic a##roach to "or( inur!/illness investigation and anal!sis is essential to an e$$ective
accident #revention #rogram% &etermining the )ene$its o$ accident anal!sis $or !our organi.ation can
hel# guide the #rocess%
Target Competency 1. Administer an accident investigation analysis program.
Performance tandardsYou will demonstrate your competence:
o )! develo#ing a $lo"chart o$ the Accident Anal!sis #rocess%
Your performance will be successful when:
o !ou de#ict all o$ the items in the accident anal!sis #rocess ste#s including #re#aration the accident
investigation itsel$ documentation and $ollo" through%
o !ou sho" the relationshi# o$ one ste# to another in seuential order%
o !ou include resources used $or accident trend anal!sis%
o !ou identi$! $actors that contri)ute to accident or illness%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% )tain the in$ormation needed to identi$! accident trends and #ro)lems areas%
)% Identi$! "ithout #lacing )lame the $actors that contri)uted to the inur! or illness%
c% Identi$! de$iciencies in the s!stem%
d% ,uggest corrective actions to #revent recurrence o$ similar "or( inur!/illness%
e% #lain #ur#oses o$ "or( inur!/illness anal!sis%
$% ist #rimar! #ur#ose o$ accident anal!sis%
g% &escri)e t"o di$$erent methods o$ accident anal!sis )ased on e#ected outcome o$ anal!sis%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% P6I* the overvie" and #er$ormance e#ectations $or this learning #lan to see "h! it
is im#ortant "hat !ou "ill learn and ho" !ou "ill )e assessed% 7ive s#ecial attention to
the introduction com#etenc! criteria conditions and learning o)ectives%
2% T8I: A;'T the conce#t o$ accident investigation anal!sis% *hat does it mean to !ou<
*h! do it< P,T !our ideas to the class discussion%
3% 6I* an online #resentation #re#ared )! the instructor on accident investigation )ene$its%
4% A,:/A,* uestions a)out ="hat it is%=
5% ead Cha#ter ne o$ Tet on =The eed $or Accident Investigation=
>% C&'CT intervie"s "ith #eo#le $rom di$$erent industries "ho conduct accidentinvestigation a)out )ene$its the! have seen in their organi.ation and the #ertinent ste#s in
their #rocess%
?% Per$orm "or(#lace ha.ard assessment to #revent inuries%
@% &iscuss "or(ers com#ensation costs "ith res#onsi)le #erson in !our organi.ation%
9% APPB #rinci#les to the develo#ment o$ an Accident Investigation Plan%
Assessment Activities 1% Com#lete $lo" chart on the accident anal!sis #rocess%
2% Com#lete a research #a#er on Pur#oses o$ *or( Inur!/Illness Anal!sis
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan
W!en to do an Accident Analysis
Overview *hat events should result in an inur! illness anal!sis% This learning #lan "ill identi$! those events andhel# the investigator determine the a##ro#riate timing $or the anal!sis%
Target Competency 2. Determine timing of injury/illness analysis.
Performance tandardsYou will demonstrate your competence:
o )! com#leting an anal!sis o$ several alternatives $or "hen to #er$orm accident investigation and
documenting !our anal!sis in a "ritten anal!sis #a#er%
Your performance will be successful when:
o !ou clari$! the decision o$ "hen to #er$orm accident anal!sis in relationshi# to the time a misha#
occurs%
o !ou include a descri#tion o$ the most im#ortant $actors to )e considered in determining timing o$ theinvestigation%
o !ou include e#lanation o$ "h! the decision "as selected%
o !ou include the decision !ou have selected%
o !ou detail an e#lanation o$ "h! the decision "as selected%
o !ou use correct grammar #unctuation and s#elling%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% Identi$! situations "hich "ould result in #ost#onement o$ accident anal!sis%
)% #lain the )ene$its o$ timel! accident investigation%
c% Identi$! incident/circumstances that "ould result in an accident anal!sis%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% T8I: a)out times "hen !ou "ere involved in an accident% *hat "ent right< *hat "ent
"rong< P,T !our thoughts to !our *or( 7rou#s &iscussion orum% es#ond at least
once to each mem)er o$ !our grou#%
2% 6I* eam#les or scenarios in "hich #rinci#les and guidelines are a##lied in var!ing
contets%
3% CAT a o) aid that #resents guidelines $or a##l!ing a #rinci#le%
4% evie" ,8A and state accident re#orting criteria and time reuirements%
5% AABD the varia)les im#acting the a##lication o$ a given set o$ guidelines%
Assessment Activities 1% Com#lete a "ritten anal!sis o$ several alternatives $or "hen to #er$orm accident
investigation and documenting !our anal!sis in a "ritten anal!sis #a#er
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan "
W!en it Comes to AccidentInvestigation# W!o $oes W!at%
Overview Anal!.ing "or( inuries and illnesses is the res#onsi)ilit! o$ all levels o$ management and a concern o$
ever! em#lo!ee% This learning #lan hel#s determine "ho does "hat%
Target Competency 3. Determine roles and responsibilities of management and workers in accident analysis.
Performance tandardsYou will demonstrate your competence:
o )! com#leting a "ritten #roduct on roles and res#onsi)ilities o$ management and "or(ers in accidentanal!sis%
Your performance will be successful when:
o !ou identi$! roles o$ management in accident anal!sis%
o !ou descri)e advantages and disadvantages o$ having certain #ersonnel #er$orm investigation%
o !ou detail ho" accident investigation roles are currentl! #er$ormed "ithin !our organi.ation%
o !ou e#lain changes !ou "ould #ro#ose $or res#onsi)ilities and roles "ithin organi.ation "ith
rationale $or changes%
o !ou use correct and a##ro#riate grammar #unctuation s#elling s!nta and "ord use in all
descri#tions%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% #lain su#ervisors uali$ications to #er$orm accident investigation%
)% &escri)e management res#onsi)ilities $or accident investigation%
c% amine role o$ $acilit! sa$et! coordinator or agenc! sa$et! manager related to accident anal!sis%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% ;AI,TE the #ros and cons o$ di$$erent individuals #er$orming accident anal!sis
i%e% su#ervisor sa$et! coordinator co-"or(er%
2% C&'CT an in$ormational intervie" using e-mail o$ a #erson in !our organi.ation "ho
has a role in accident investigation%
3% ead tet Cha#ter ne =The eed $or Investigation= #ages 10-15 a)out roles o$
su#ervisors/management
4% CCT current articles that relate to roles and res#onsi)ilities o$ #ersonnel involved in
accident investigation%
5% APPB #rinci#les to the develo#ment/modi$ication o$ an accident investigation #lan $or!our $acilit!%
Assessment Activities 1% Com#lete a "ritten #roduct on roles and res#onsi)ilities o$ management and "or(ers in
accident anal!sis
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan &
Im'ortance of Accident (e'orting
Overview Accurate and immediate accident re#orting are im#erative to an accident investigation s!stem%
Target Competency . !nsure reporting of work injuries/illnesses.
Performance tandardsYou will demonstrate your competence:
o )! com#leting an error anal!sis re#ort o$ "or( inur!/illness re#orting%
Your performance will be successful when:
o !ou identi$! all critical errors in the in$ormation or #rocess o$ inur! re#orting "ithin !our
organi.ation%
o !ou includes su)tle )ut im#ortant errors noted such as late re#orting o$ accidents no re#orting o$
near miss accidents and descri)es method o$ determining that these errors have occurred%
o !ou e#lain identi$ied errors%
o !ou anal!.e the e$$ect o$ the errors on accident re#orting%
o !ou ma(e recommendations $or correcting the errors "ithin the organi.ation including suggestions $or
training o$ em#lo!ees as needed%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% &escri)e accident re#orting #rocess%
)% Identi$! #ossi)le de$iciencies in re#orting accidents%
c% Communicate re#orting #rocess to "or(ers and su#ervisors%
d% Train em#lo!ees involved in accident investigation #re#aration%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% T8I: A;'T the uestion *h! arent Inuries/Illnesses re#orted<
2% I,T to a lecture a)out accident re#orting including minor inuries and near misses%
3% Com#are accident $orm currentl! in use in !our organi.ation to the ,8A 301 $orm
availa)le at """%osha%gov under record(ee#ing% Eodi$! !our current $orm to include
sections o$ ,8A 301 $orm not included%
4% ead tet Cha#ter ourteen =*here &id Eanagement ail<=
5% I,T several interesting ideas techniues strategies and tactics $rom this learning sessionF
then &,CI; #ossi)le a##lications to !our o"n "or( role%
>% ead tet Cha#ter ,iteen The Eisha# e#ort=
?% Com#are various given $orms and select $orm to use in an accident re#orting chec(list
@% Include a list o$ to#ics on "hich to train em#lo!ees on accident re#orting #rocedures%
9% evie" =Accident Investigation= module in ,a$et! Pa!s meeting )oo( $rom ;ureau o$
;usiness Practice%
Assessment Activities 1% Com#lete an error anal!sis re#ort o$ "or( inur!/illness re#orting
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan )
Before t!e Accident Occurs* +o,to Pre'are
Overview *hen a co-"or(er is inured ever!one is concerned% The )est "a! to hel# is to arrive at the accident
scene "ith the tools and materials needed to do the accident anal!sis% The accident investigation (it
should include tangi)le o)ects and mental tools%
Target Competency ". #repare for accident analysis.
Performance tandardsYou will demonstrate your competence:
o )! develo#ing a $lo"chart o$ the Accident Anal!sis #re#aration #rocess%
Your performance will be successful when:
o !ou identi$! ha.ard anal!sis an investigation (it and contents communication "ithin the $acilit!
location o$ $orms/materials%
o !ou identi$! investigation (it and contents%
o !ou identi$! communication methods "ithin the organi.ation%
o !ou locate $orms/materials $or an accident anal!sis%
o !ou e#lain the relationshi# o$ one ste# to another%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% Communicate #ro#er noti$ication #rocedures%
)% nsure that ever! em#lo!ee clearl! understands "hat events need to )e re#orted%
c% Pre#are inur!/illness anal!sis (it%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% I,T to !our instructor share an eam#le a)out Accident Investigation Pre#aration%
2% ead tet Cha#ter T"oG =Pre#aring $or Eisha#s=
3% PATICIPAT in a small grou# discussion o$ "hat to include in an =Accident
Investigation :it=
4% &iscuss the conce#t o$ $act $inding not $ault $inding
5% CAT a #rocedure chec(list $or an =Accident Investigation :it=
>% AABD the varia)les im#acting the a##lication o$ a given set o$ guidelines%
?% *IT =ho" to= directions $or accident investigation #rocedure%
@% Pre#are em#lo!ee training material list%
Assessment Activities 1% &evelo# a $lo"chart o$ the Accident Anal!sis #re#aration #rocess
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan -
+o, to .anage t!e Accident Scene
Overview An inur!/illness scene can )e a chaotic #lace% *ithout #ro#er control #riorities ma! not )e esta)lishedand e$$ective res#onse does not occur% This learning #lan hel#s set #riorities and restrict access so
valua)le in$ormation is not lost
Target Competency $. %anage t&e accident scene.
Performance tandardsYou will demonstrate your competence:
o )! com#leting a "ritten #roduct on managing the accident scene%
Your performance will be successful when:
o !ou identi$! #ur#oseHs o$ managing accident scene%
o !ou e#lain the roles o$ #ersonnel "ithin !our organi.ation as "ell as local outside emergenc!
resources%
o !ou #rioriti.e actions at the scene in chronological order%
o !ou ma(e recommendations $or incor#orating scene management into organi.ations "ritten
emergenc! res#onse #rogram%
o !ou use correct and a##ro#riate grammar #unctuation s#elling s!nta and "ord usage%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% Provide care and treatment o$ inured "or(er%
)% liminate or control remaining ha.ards%
c% estrict access to the scene o$ the accident%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning Activities 1% JAEI the com#etenc! and #er$ormance standards $or this learning #lan%
2% ead tet Cha#ter Three =7etting 'nder"a! "ith Investigation=
3% &I conce#ts o$ scene securit! ha.ard elimination and care o$ the inured "or(er )!
revie"ing selected readings%
4% ead tet Cha#ters our =8uman As#ects Cha#ter ive =The nvironment= and Cha#ter
,i =The Eaterials=
5% ist t!#es o$ ha.ards that ma! )e #resent%
>% CCT current articles that relate to conce#ts and issues relating to Eanaging Accident
,cenes%
?% APPB #rinci#les to the com#letion o$ a occu#ational tas( o$ managing accident scene in a
de$ined scenario%
Assessment Activities 1% Com#lete a "ritten #roduct on managing the accident scene
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan
Performing t!e Accident Analysis
Overview 6arious $acts concerning inuries and illness events must )e discovered )e$ore an anal!sis is com#leted%It is im#ortant to gather this in$ormation $rom a variet! o$ sources to avoid overloo(ing im#ortant
in$ormation% This learning #lan hel#s the investigator e#lore sources including the a$$ected "or(er
"itness accounts #h!sical evidence at the scene and eisting records%
Target Competency '. (onduct Accident Analysis.
Performance tandardsYou will demonstrate your competence:
o in the "or(#lace leaner #er$orms an accident investigation "ith documentation under su#ervision o$
someone "ith e#erience in accident investigation%
Your performance will be successful when:
o !ou select the correct materials su##lies tools needed $or the accident investigation Hinvestigation(it%
o !ou #er$orm all critical ste#s in the right order including $act gathering "itness intervie"
#hotogra#hs documentation%
o !ou descri)e method !ou have selected $or investigation #rocess and cite re$erence%
o !ou "ear #ersonal #rotective eui#ment%
o !ou $ollo" sa$et! #rocedures "ithin the $acilit! as !ou #er$orm accident investigation%
o !ou ver)ali.e an e#lanation o$ the #rocess as !ou #er$orm it%
o !our e#lanation #resents sound reasoning as !ou descri)e the decisions !ou ma(e throughout the
#rocess%
o !ou su)mit "ritten critiue $rom e#erienced investigator o)serving !our investigation%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% 7ather in$ormation a)out the accident%
)% Intervie" the a$$ected "or(er%c% )tain "itness account%
d% Identi$! condition o$ machiner! and eui#ment in the area or the accident%
e% amine materials $ound at the scene%
$% ote environmental conditions at the scene o$ the accident%
g% ecord im#ortant details o$ the scene using s(etches or #hotogra#hs%
h% amine eisting records that ma! im#act anal!sis%
i% valuate legal considerations%
% Assess conditions $or use o$ re-enactment as accident anal!sis tool%
!earning Activities 1% JAEI the tools availa)le $or this learning #lan%
2% A& an occu#ationall! related article in a current #eriodical%
3% A& an assignment in the tet)oo( Cha#ter Three =7etting 'nder"a! "ith the
Investigation= ead Cha#ter ,even =,!stems Investigation=
4% 6I* eam#les or scenarios in "hich #rinci#les and guidelines are a##lied in var!ing
contets%
5% CAT a o) aid that #resents the ste#s o$ an Accident Investigation #rocedure citingre$erence%
>% 6ie" =Accident Investigation= video #art o$ =,a$et! Pa!s= meetings #rogram%
?% && a method o$ investigating accidents $rom source selected either the tet the
ational ,a$et! Councils Accident Investigation H2nd dition or $rom =AccidentInvestigation Techniues = )! Ke$$re! ,% a(le!
@% Practice intervie" techniue $or uestioning a$$ected "or(er using A##endi ; o$ ,tate o$
*isconsin &e#artment o$ Administrations =Princi#les o$ Inur!/Illness Investigation and
Anal!sis= availa)le at ,tate o$ *isconsin &e#artment o$ Administration *e)site
9% 6A'AT the #er$ormance o$ a #rocedure according to a #rocedure ta)le or chec(list
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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10% &iscuss e$$ective #rocedures $or o)taining "itness accounts
11% ', a o) aid H$orm that #resents the ste#s o$ a #rocedure% e$erence source o$ $orm
Assessment Activities 1% In the "or(#lace #er$orm an accident investigation "ith documentation under su#ervision
o$ someone "ith e#erience in accident investigation%
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Accident Investigation
Learning Plan 0
$etermining Accident Causes
Overview *ithout accurate and detailed in$ormation a)out the causes o$ accidents e$$orts to #revent $utureaccidents "ill #ro)a)l! )e $utile% This learning #lan hel#s to identi$! #rimar! and secondar! causes o$
accidents "ith the goal o$ #reventing recurrence%
Target Competency ). Determine accident cause.
Performance tandardsYou will demonstrate your competence:
o )! #re#aring a "ritten res#onse to a case stud! #rovided )! the instructor%
Your performance will be successful when:
o !ou identi$! #rimar! cause and secondar! $actors causing the accident%
o !ou determine human as#ects as "ell an environmental $actors o$ the accident%
o !ou e#lain #rimar! cause o$ accident including su##ort $or cause%
o !ou res#ond using correct grammar #unctuation and s#elling%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% A##l! si )asic causes o$ inuries/illness in the "or(#lace to each accident%
)% Identi$! secondar! causes in accident anal!sis%
!earning Activities 1% ,-6A'AT !our current s(ill level $or this com#etenc!%
2% 6I* de$inition o$ unsa$e acts and unsa$e conditions $rom ational ,a$et! Councils
=Accident Investigations=%
3% 6I* eam#les or scenarios #rovided )! instructor in "hich #rinci#les and guidelines
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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are a##lied in var!ing contets%
4% evie" =,i :e! Luestions $or Inur!/Illness Anal!sis= A##endi A o$ ,tate o$
*isconsin &e#artment o$ Administrations =Princi#les o$
5% ead tet Cha#ter i$teen =ire Investigation= and Cha#ter Ten =Change Anal!sis= and
Cha#ter T"elve =Eultilinear vents ,euencing=
>% &ITIAT )et"een eam#les and non-eam#les o$ a conce#t such as unsa$e act
and unsa$e )ehavior%
?% CA,,IB eam#les #rovided )! instructor according to conce#t%
@% CA,,IB in$ormation using one o$ the techniues descri)ed in tet Cha#ter ight =;asic
Anal!tical Techniues=
9% APPB #rinci#les to the solution o$ case stud! #ro)lems #rovided in Accident Investigation
section o$ =,a$et! Pa!s%= meeting )oo( $rom ;ureau o$ ;usiness Practice%
10% APPB #rinci#les to the solution o$ real occu#ational #ro)lem solving not involving
accidents%
Assessment Activities 1% Pre#are a "ritten res#onse to a case stud! #rovided )! the instructor
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan
$etermining and Im'lementingCorrective Actions
Overview I$ the ultimate o)ective o$ an inur!/illness anal!sis is to #revent similar inuries/illnesses $rom occurring
recommendations to eliminate or control each cause o$ the inur!/illness need to )e develo#ed and $ull!
im#lemented%
Target Competency *. Develop and recommend corrective actions to prevent accident recurrence.
Performance tandardsYou will demonstrate your competence:
o )! "riting a #ro)lem/solution re#ort a)out corrective actions recommended $or a s#eci$ic case stud!
su##lied )! the instructor%
Your performance will be successful when:
o !ou anal!.e o$ the causeHs o$ the accident%
o !ou identi$! the $actors involved such asG management environment communication #ro)lems
human limitations and s!stems investigations%
o !ou e#lain via)le corrective actions%
o !ou identi$! the corrective actionHs most li(el! to #revent reoccurrence o$ the accident%
o !ou descri)e method such as ault Tree or ET HEanagement versight and is( Tree $orm tet
used to arrive at conclusions%
o !ou descri)e ho" the im#lementation o$ the corrective action "ill )e documented%
o !ou use correct grammar #unctuation and s#elling%
!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% ,tate "hat s#eci$ic ste#s ta(en )! "hom "ill constitute corrective action%
)% #lain "hen and ho" su#ervisor "ill assure that each corrective action is carried out correctl!%
c% Consider im#act each recommendation "ill have u#on #roductivit! the cost o$ services and the
amount o$ su#ervision reuired to im#lement and monitor the corrective action%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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d% valuate the $easi)ilit! o$ im#lementing along "ith acce#tance o$ the recommendation )!
management and em#lo!ees%
!earning Activities 1% *IT do"n "hat !ou alread! (no" a)out determining corrective actions
2% A& an assignment in the tet)oo( on corrective actions Cha#ter Thirteen =Technic o$
#erations evie"= Cha#ter ,eventeen =Eanagement vervie" and Eisha#
Investigation= and Cha#ter ighteen egal As#ects o$ Investigation%
3% 6I* eam#les or scenarios in "hich #rinci#les and guidelines are a##lied in var!ing
contets%
4% ,CT a method $or com#leting a corrective action audit
5% ,CT (e! #oints $rom a reading on correcting de$iciencies in the management s!stem%
>% T';,8T the corrective action #rocedure in !our organi.ation%
?% 'TI the ideas and conce#ts #resented in this learning #lan%
Assessment Activities 1% *rite a #ro)lem/solution re#ort a)out corrective actions recommended $or a s#eci$ic case
stud! su##lied )! the instructor%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Accident Investigation
Learning Plan 12
$ocument# $ocument# $ocument
Overview The investigation and anal!sis o$ an accident are onl! as good as the documentation o$ the #rocess% Thislearning #lan "ill hel# determine "hich $orms to use as "ell as legal record(ee#ing reuirements%
Target Competency 1+. Document accident analysis.
Performance tandardsYou will demonstrate your competence:
o )! documenting case stud! accident su##lied )! instructor on government $orms as reuired%
o )! documenting accident anal!sis o$ case stud! su##lied )! instructor on $orms either #rovided )! the
instructor or $orms currentl! used in "ithin !our organi.ation%
Your performance will be successful when:
o accident investigation $orms #resent current accurate and com#lete data%
o records are legi)le or are #re#ared using "ord #rocessing%
o records sho" correct use and s#elling o$ #ro$essional/technical terminolog!%
o records include diagrams and charts H"hen #resent or needed that are accuratel! la)eled and or
com#leted according to instructions on the $orm%
o records conclusions and recommendations are "ritten using standard nglish and correct usage
#unctuation s#elling%
o records are signed and dated%
o corrective actions are documented on the accident $orm%
o ma(ing recommendations $or $orms currentl! used "ithin the organi.ation that do not meet the criteria
o$ the current ,8A 301 $orm or its euivalent%
o document on current ,8A 300 $orm as a##ro#riate $or conditions in case stud! in accordance "ith,8A 1910%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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!earning ObjectivesThis learning plan addresses the following learning objectives to help you master the competency:
a% Com#lete accident investigation "ithin 24 hours a$ter noti$ication%
)% valuate $orms%c% Identi$! "or(er noti$ication #rocedures and $orms%
d% Consider "or(ers com#ensation noti$ication reuirements%
e% Com#are inur!/illness circumstances to ,8A record(ee#ing and document accordingl!%
!earning Activities 1% CEPT the sel$-chec( on Accident Anal!sis &ocumentation $rom A##endi o$ the
=Princi#les o$ Inur!/Illness Investigation and Anal!sis= located at the ,tate o$ *isconsin
&e#artment o$ Administration "e)site%
2% 6I* an online #resentation on ,8A ecord(ee#ing at """%osha%gov "e)site under
training in$ormation%
3% 6I* de$initions o$ ,8A terms involved "ith record(ee#ing
4% ead tet Cha#ter ,iteen =The Eisha# e#ort=
5% ead tet Cha#ter ineteen =*hat is Ahead $or Accident Investigation=
>% CA,,IB in$ormation $rom instructor re$erenced case studies as ,8A recorda)le or not%
?% evie" =Accident e#orts= ,ection o$ =Princi#les o$ Inur!/Illness Investigation and
Anal!sis= availa)le at ,tate o$ *isconsin &e#artment o$ Administration "e)site%
@% CEPT a "or( sheet/assignment sheet di$$erentiating ,8A recorda)ilit! and
"or(ers com# re#orting%
9% PE a sam#le entr! onto ,8A 300 log "ith in$ormation $rom eam#le case studies
in Accident Investigation ,ection o$ ,a$et! Pa!s Eeeting ;oo( $rom ;ureau o$ ;usiness
Practice
10% Contact the "or(ers com#ensation carrier $or !our organi.ation to $ind out reuired
re#orting $orms method and timeline%
Fox Valley Technical College +Co#!right ,e#tem)er 2004
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Assessment Activities 1% PE sam#le o$ "or(ers com#ensation noti$ication o$ inur! $or !our $acilit! a$ter
locating current $orm at ,tate o$ *isconsin &e#artment o$ Administration *e) site%
2% &ocument case stud! accident su##lied )! instructor on government $orms as reuired%
3% &ocument accident anal!sis o$ case stud! su##lied )! instructor on $orms either #rovided
)! the instructor or $orms currentl! used in "ithin !our organi.ation%