Accident Investigation

Presented by

NameTitleDate

Course Outline

Four modules1. Definitions2. Causation3. Investigations4. Case study

Workshop Objectives

• When to do a formal investigation• Immediate and fundamental causes• When to give notification of an accident • How to write a good accident report with recommendations

You will gain an understanding of

Module 1 - Definitions

• Accident • Incident• Accident Investigation

Accident - Can be defined as an unplanned event that interrupts the completion of an activity, and that may (or may not) include injury or property damage. Incident - Usually refers to an

unexpected event that did not cause injury or damage,but had the potential to do so.

How does your workplace define these terms?

Definition of Accident & Incident?

What is an Accident Investigation?

An accident investigation is a conscientious examination of all factors leading up to and included in an incident or accident…

Why should we investigate?

Reasons to investigate a workplace accident include: · most importantly, to find out the cause of accidents to prevent similar accidents in the future· to fulfill any legal requirements· to determine the cost of an accident· to determine compliance with applicable safety legislation· to process workers' compensation claims

Module 2 - Finding the Causes

• Immediate and basic• Accident statistics

?

Finding the Causes

Why are we having

accidents?

Immediate Causes

Substandard Conditions• Inadequate protective equipment• Defective tools, equipment, materials• Poor housekeeping• Inadequate ventilation• Congested or restricted action

Immediate Causes

Substandard Acts/Practices• Operating equipment without authority• Operating at improper speed• Removing safety devices• Failure to use PPE/warn/secure/follow

procedures• Horseplay• Under influence of alcohol/drugs• Improper loading/lifting/placement

Basic Causes

Personal Factors Inadequate physical/mental capability

Lack of knowledge Lack of skill Stress Improper motivation

Basic Causes

Job Factors Inadequate:

- Unclear/conflicting leadership

- Engineering - Purchasing- Maintenance- Tools, equipment, materials- Work standards

Wear and tear

Abuse and misuse

Improper training

Accident Ratios

1

Serious

10 - Minor

30 - Property Damage

600 - Near Misses

Report and investigate all accidents and incidents

Iceberg EffectAccidents Cost Money

Insured Costs•Medical •Compensation

Uninsured Costs•Building damage•Tool and equipment damage•Product and material damage• Hiring and training replacements• Investigation time

$1

$5 to $50Property Damage

$1 to $3Miscellaneous

Module 3 - Investigate

• Reporting• Investigation procedures

Committee may…

• 15(j) participate in all inspections, inquiries and investigations concerning the health and safety of employees, and in particular the investigation of any matter referred to in section 43

• 15(i) investigate any complaint…

Notices by Employers

• 43(1) Injuries causing fatality, loss of limb or occupational disease, notify WorkSafeNB immediately.

• 43(2) The employer shall immediately notify JHSC or representative.

To report health and safety emergencies: 1 800 222-9775

Notices by Employers

43(3) No person shall disturb the scene, except  (b) to prevent further injuries; or(c) to protect property that is endangered as a result of the accident.

43(4) An accidental explosion, or an accidental exposure, notify WorkSafeNB within 24 hours.

To report exposures or explosions: 1 800 222-9775

Terms of Reference

The size and scope of an investigation team as well as its purpose, duties and objectives should be clearly explained in the terms of reference or an investigation policy.

Ensuring Accident Reporting

• Initial training - all incidents must be reported• Encouragement - thank the individual• Take immediate action on all reports• Reinforce the importance of accident investigations whenever possible

• Never place blame, as everyone is responsible

Why Accidents May Not be Reported

• Doesn’t want to be central person • ‘Spoils’ safety record• Fear/dislike of medical treatment• Afraid co-workers will ‘kid’• Doesn’t like ‘red-tape’• Afraid supervisor will be angry• Doesn’t want to lose time

It is to:

• Find all causes• Prevent re-occurrence• Ensure due diligence at every level• Reduce accidents/costs• Show workers that management cares about

h&s

Purpose of an Accident Investigation

It is not:

• Filling out an accident report (Form 67, application for claim)

• Fixing blame/finger pointing• To be conducted with a courtroom mentality

Purpose of an Accident Investigation

Policy

• All incidents/accidents will be investigated• Front line supervisor will conduct investigations• How recommendations will be applied and assessed• Employees are encouraged to report all

incidents/accidents

Every employer should have a written policy & procedure. The policy should include the following points:

Procedures (Detailed)

Steps to take when doing an incident investigation:

1. Encourage all staff to report incidents immediately2. Examination of the situation by supervisory staff3. Take immediate measures, if necessary4. Refer to JHSC for follow-up

Procedures (Detailed)

Steps to take when doing an accident investigation:

1. Initial response activities2. Collect relevant information3. Analyze information4. Write report5. Follow up

Supervisor as Accident Investigator

•Two different viewpoints: ‘This is an opportunity to prevent the next accident.’

‘This is unnecessary paperwork and an improper use, waste of my time’

Key Attributes of Competent Investigators

• Assumes all accidents are preventable• Looks for many causes not just the first, most obvious cause

• Be a good listener• Never attempts to find a culprit• Is as objective as possible• Always keeps the purpose of the investigation in mind

Investigation Kit

• Camera, film, and flash• Tape measure• Clipboard/pad• Flashlight• Pencils/pens• Accident Investigation Form • Investigation policy• Chalk (yellow/white)• Checklist

JHSC

Investigation

Kit

Interview Techniques

1. Try to have private interviews2. Put the person in the right frame of mind3. Get their story in their own words4. Probe for the full understanding5. Conclude the interview on a positive note

Questions to answer

• Who?• What?• Where?• When?• Why?• How?

Points to Remember

• Be conscious of the feelings of others• Arrange for comfortable quarters in which to interview

• Don’t jump to conclusions or pre-judge• Don’t let your personal bias take over• Never pass on information given to you in confidence by another party

• Stick around after you have finished your formal investigation

Investigation Report

• The report should include the pertinent information collected from all sources, as well as the immediate and basic causes, and recommended actions to be taken

• Should respect confidentiality• Recommendations should be concrete, precise, realistic and measurable

Module 4 - Case Study

• It is now time to investigate an accident

Another Option• The group may prefer to investigate an accident that has already occurred at their workplace

Summary

• Of the difference between accident & incident• That root causes are the real reasons as to why accidents are occurring

• That a proper investigation will reduce probability of accidents re-occurrence

During this session, you were made aware:

Effective accident investigations prevent physical injury, reduce costs, and contribute

to the safety mindset of the workplace.