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ACCIDENT INVESTIGATION AND REPORTING

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Presentation on theme: "ACCIDENT INVESTIGATION AND REPORTING"— Presentation transcript:

1 ACCIDENT INVESTIGATION AND REPORTING
AR DA PAM This block of instruction is based on the requirements of AR and DA PAM , Army Accident Investigation and Reporting. The primary purpose of the safety program is accident prevention. When prevention fails, the accident investigation attempts to determine how to prevent recurrence.

2 Accident Investigation Publications
ACCIDENT INVESTIGATION AND REPORTING Accident Investigation Publications AR Accident Reporting and Records, Nov 94 Provides policy and procedures and assigns responsibility for notification, investigation, reporting, and submission of Army accident reports. DA Pam Army Accident Investigation and Reporting , 1 Nov 94 Army Accident Investigation “HOW TO” manual for aviation and ground accidents.

3 ACCIDENT INVESTIGATION AND REPORTING
TERMINAL LEARNING OBJECTIVE: ACTION: Investigate / report Army accidents CONDITIONS: As a safety NCO / unit leader STANDARDS: IAW AR & DA PAM Often when a serious accident occurs, unit personnel do not know what to do or who is responsible for the accident investigation. Following completion of this instruction you should be able advise the commander and unit personnel on accident investigation responsibilities, and procedures. You should be able to determine if an incident is an Army accident, determine notification requirements, identify investigation and reporting responsibilities, and take the immediate action necessary to secure the accident site. If the accident involves fatal injuries, serious injury, or high dollar loss, a more detailed, in-depth investigation is conducted to determine if unit and higher level prevention measures can be identified. As the unit safety officer/ NCO, you will advise the commander on these responsibilities. You will investigate and report accidents or participate in the investigation and reporting of unit accidents.

4 ACCIDENT INVESTIGATION AND REPORTING
PURPOSE OF ACCIDENT INVESTIGATION DEFINE ARMY ACCIDENT ACCIDENT INVESTIGATION RESPONSIBILITIES CLASSIFICATION OF ACCIDENTS REPORTING AND RECORDING ARMY ACCIDENTS CATEGORIES OF INVESTIGATION REPORTS INVESTIGATION PROCEDURES ACCIDENT REPORTING TERMINOLOGY During this block of instruction, we will discuss these 8 specific areas related to accident investigation and reporting. Following completion of this training, you should be able to answer the following questions: Why does the Army investigate accidents and what is the information used for? Is this incident an Army accident? Who has responsibility for investigating and reporting the Army accident? Is the DA 285 or AGAR required for reporting this accident? What investigation process and procedures must be followed?

5 ACCIDENT INVESTIGATION AND REPORTING
WHY INVESTIGATE / REPORT ACCIDENTS? “Those who do not learn from their mistakes are doomed to repeat them.” Why do you think the Army investigates accidents? Students often say: “To determine who to hang.” “To find out who is at fault.” The RIGHT answer in to identify cause factors to prevent repeat of similar incidents. Accident investigations are for prevention purposes.

6 ACCIDENT INVESTIGATION AND REPORTING PURPOSE OF INVESTIGATION / REPORTING THE INVESTIGATION DETERMINES: WHY DID IT HAPPEN? SYSTEM INADEQUACY / ROOT CAUSE WHAT HAPPENED? CAUSE FACTORS WHAT TO DO ABOUT IT? RECOMMENDATIONS HUMAN ERROR / MISTAKE MATERIEL FAILURE ENVIRONMENTAL FACTOR The purpose of accident investigation is prevention. The objective of accident investigation is to determine what happened: the facts in the accident: who was injured, who was involved, what was the series of events, when did it occur, what equipment was involved and how much damage occurred. The accident investigation looks at 3 primary areas: Human factors, such as training, supervision, procedures, and individual capabilities and actions. Materiel factors such as equipment malfunctions or failures that caused or lead to the accident. Environmental factors, such as noise, illumination, space and weather conditions (temperature, precipitation, humidity, pressure, wind, lightning) having an adverse effect on the individual or equipment so that an accident occurs. Environment is not a factor if the condition was known and could have been avoided before the accident. Once the facts are determined, the information is analyzed to determine “why it happened”. This is to determine the root cause. Cause factors fit into one or more of 5 cause factors. The cause factors determined in block 2 are the basis for developing findings and recommendations. These may be unit level, higher level, or Army level SUPPORT LEADER TRAINING STDS / PROCEDURES INDIVIDUAL FIXES CONTROL MEASURES COUNTERMEASURES

7 ACCIDENT INVESTIGATION AND REPORTING PURPOSE OF INVESTIGATION/REPORTING:
Identify accident cause factors and system deficiencies Assess manpower and monetary losses due to accidents Collect accident data to develop accident prevention measures Prevention only (not to be used for litigation, claims, disciplinary action, or adverse administrative actions) AR defines these purposes for accident investigation. Accident investigation must determine the root cause to prevent this accident from recurring in this unit and similar units and operations. Accident investigation may identify training deficiencies, inadequate equipment, poor written procedures and standards, leadership inadequacies, or support failures. Accident investigations can identify hazards or malfunctions applicable equipment systems Army-wide. Chief of Staff, Army (CSA) is briefed quarterly on Army accidents, including the number of Army accidents, accident costs, and types of accidents. This accident data is collected and analyzed at Army level by the USASC. The Army implements prevention programs based on accidents occurring Army-wide. Safety accident investigations are for prevention purposes. The accident investigation report may not be used for disciplinary or adverse action.

8 ACCIDENT INVESTIGATION AND REPORTING LEGAL / REGULATORY REQUIREMENTS:
OCCUPATIONAL SAFETY AND HEALTH ACT (OSHA) PL EXECUTIVE ORDER 12196 29 CFR 1960, FEDERAL OSHA PROGRAM DOD INSTRUCTION AR DA PAM Accidents are investigated to collect data for accident prevention. There is also a legal basis for accident investigation and reporting. Federal law requires that all federal agencies investigate and report accidents to determine the causes and take appropriate prevention measures. OSHA law requires federal agencies to investigate accidents, collect accident data, and develop appropriate prevention programs. EO directs federal agencies to implement a safety program including collection of accident data. DODI provides specific guidance on the classification of accidents and directs collection and analysis of accident data. DOD defines what is and is not an accident and which accidents are reportable. AR provides the specific Army policy and guidance for accident investigation and reporting. DA PAM is the the how to manual for accident investigation. The DA PAM includes notification requirements and in-depth accident investigation procedures for serious accidents investigated by an accident investigation board.

9 DEFINITION - ACCIDENT ACCIDENT - an unplanned event that causes personnel injury or illness, or property damage. This is the definition of accident as published in AR The definition is pretty broad. For that reason the Army further defines Army accident. AR , TERMS

10 DEFINITION - ARMY ACCIDENT
ARMY ACCIDENT - an accident that results in injury / illness to either army or non-Army personnel, and/or damage to Army or non-Army property as a result of Army operations (caused by the Army). Army accident - limits the area of concern to incidents where the Army experiences a loss (damage or injury) or where the Army may be liable for damage or loss as a result of Army operations. AR , TERMS

11 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
PERMANENT TOTAL DISABILITY - Any nonfatal injury or occupational illness that in the opinion of the competent medical authority, permanently and totally incapacitates a person to the extent that he or she cannot follow any gainful employment. The loss, or loss of use of both hands, feet, eyes, or any combination thereof as a result of a single accident. A Permanent total disability is what class of accident? Class A What would be an example of a permanent total disability? Fall resulting in broken back and paralysis…. Blindness due to a chemical splash AR , TERMS

12 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
PERMANENT PARTIAL DISABILITY - Any injury or occupational illness that does not result in death or permanent disability but, in the opinion of the competent medical authority, results in the loss or permanent impairment of any part of the body with the following exceptions: Loss of teeth Loss of fingernails or toenails Loss of tip of finger or tip of toe Hearing loss Example - finger crushed /cut off in maintenance accident….

13 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
LOST-TIME CASE- A nonfatal traumatic injury that causes any loss of time from work beyond the day or shift on which it occurred or a nonfatal non-traumatic illness / disease that causes loss of time from work or disability at any time. A lost time case results in a Class _ Accident? Class C An example might be a soldier injured playing basketball is placed on quarters for 2 days for his strained knee. AR , TERMS

14 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
LOST-WORKDAY CASE- Cases in which an accident results in Army personnel missing one or more days of work. Days away from work are those workdays (consecutive or not) on which Army personnel would have worked but could not because of injury, occupational illness, or job-related physical deficiencies detected during medical surveillance examinations. A lost time case results in a Class _ Accident? Class C An example might be a soldier injured playing basketball is placed on quarters for 2 days for his strained knee. AR , TERMS

15 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
NONFATAL CASE WITHOUT LOST WORKDAYS - (Light duty / restricted work activity) - cases other than lost workday cases where army military, civilian personnel, because of an injury or occupational illness, experienced one or more of the following: Permanent transfer to another job or termination. Loss of consciousness Restricted duty (profile) AR , TERMS

16 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
INJURY- A traumatic wound or other condition of the body caused by external forces, including stress or strain. The injury is identifiable to time and place of occurrence and member or function of the body affected, and is caused by a specific event or incident or series or events or incidents within a single day or work shift. Injury involves a single event…. Fall, strain, struck by an object… etc…. AR , TERMS

17 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
OCCUPATIONAL ILLNESS - Nontraumatic physiological harm or loss of capacity produced by systemic infection; continued or repeated stress or strain; exposure to toxins, poisons, fumes, etc., or other continued and repeated exposures to conditions of the work environment over a long period of time. A condition that does not meet the definition of an injury. Occupational injury is due to repeated strain … repeated exposure to a chemical…. Muscle strain due to repetitious work... AR , TERMS

18 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
MEDICAL TREATMENT- Any treatment (other than first aid) administered by a physician or by registered professional medical personnel under orders of a physician AR , TERMS

19 ACCIDENT INVESTIGATION AND REPORTING - AR 385-40 ACCIDENT REPORTING TERMINOLOGY
FIRST AID - One-time medical treatment for minor scratches, cuts, burns, and similar injuries that do not ordinarily require medical attention, plus any follow-up visits for observation. Such one-time treatment and follow-up visits will be considered first aid, even if provided by a physician. AR , TERMS

20 WHAT TO INVESTIGATE / REPORT - Commanders will investigate / report:
Damage to Army property. Injury (fatal or nonfatal) to military personnel Injury to on-duty civilian personnel Occupational injury or illness (fatal or nonfatal) to military personnel or Army civilian employees Investigation and reporting is required for the following Army accidents. Damage to Army property may be due to Army personnel actions, environmental conditions such as lightning, or as a result of the actions of non-Army personnel. The amount of damage is used to determine if investigation and reporting responsibilities. Military personnel reportable injuries may be from on-duty or off-duty activities. It does not matter whether the injury is from tactical operations and training or garrison activities such as sports and recreation injuries. Civilian personnel injuries are reportable for work-related injuries. Occupational injuries are work related injuries or illness from more than one time exposure to a hazardous condition. Examples: Hearing loss. Cancer or lung damage from long term exposure to workplace chemicals. AR , 2-3

21 WHAT TO INVESTIGATE / REPORT - Commanders will investigate / report:
Injury / illness to non-Army personnel as a result of Army operations. Damage to non-Army property as a direct result of Army operations. Class E Aviation incident FOD incidents (class F) Non-Army personnel may be injured as a result of Army operations. Example: An Army 5 ton truck runs through a stop sign and hits a civilian privately owned vehicle. The Army is liable for injury to non-Army personnel if the Army would be considered at fault or responsible for the injury. damages to the civilian vehicle and this would be an Army accident even if the Army vehicle sustained no damage or only minor damage. Non-Army property damage may occur as a result of Army operations. Example: An Army 5 ton truck runs through a stop sign and hits a civilian privately owned vehicle. The Army is liable for damages to the civilian vehicle and this would be an Army accident even if the Army vehicle sustained no damage or only minor damage. Class E aviation incident

22 OCCURRENCES - NOT AN ARMY ACCIDENT
Combat losses Directly caused by enemy action Due to evasive action taken to avoid enemy fire Failure to return from a combat mission Malfunction or failure of component parts Of course combat losses are not considered accidents. If the loss occurred as a result of evasive action, the loss is not considered an Army Accident. During Desert Storm several accidents occurred when aircraft were flown into the ground during low level flight. These incidents are Army accidents unless the incident occurred while engaging or evading the enemy. When a component fails and that is the only damage - it is not an Army accident. If a component fails and additional damage occurs - it is an Army accident. For example, the brakes fail on a 5 ton truck. If the truck stops without incident, it is not reported as an Army accident. If the driver loses control and wrecks the vehicle - the incident is an Army accident. AR , 2-5

23 OCCURRENCES - NOT AN ARMY ACCIDENT (CON’T)
Expected damage (testing) Property damage as a result of vandalism, riot, civil disorder, felony Deliberate damage to aircraft or equipment or to occupants Accidents occurring during transport by commercial carrier Damage due to destructive testing of equipment is not an Army accident Criminal acts, vandalism and sabotage are not Army accidents. Terrorist acts are not accidents. Commercial carrier losses are not considered Army accidents. Reasoning is the Army was not in control and the Army member just happened to be using the transportation system.

24 NONREPORTABLE INJURIES / ILLNESSES
NONOCCUPATIONAL ILLNESS / INJURY - Injury / illness is not proximate cause. Example -excessive bleeding of hemophiliac SELF-INFLICTED INJURIES - Suicide or self-inflicted injury CRIMINAL ASSAULT - Fist-fight or brawl PRIOR-SERVICE INJURIES - Injury prior to service entry Non occupational injury - the injury itself is not the problem - individual sensitivity. Example - death as a result of a bee sting. Self-inflicted - drunk and punched out a vending machine (broken hand) - not reportable. Criminal assault - fist-fight or brawl is not an accident Prior-service injuries - injury prior to service entry is not reportable since the injury is not due to Army activities. AR , 2-7

25 NONREPORTABLE INJURIES / ILLNESSES
INFECTIVE AND PARASITIC DISEASE - Example - respiratory disease or food-poisoning STRAINS - Resulting from pre-existing musculoskeletal disorder (strain occurs during sneeze) HOSPITALIZATION (OBSERVATION ONLY) ESCAPE FROM CUSTODY - Injury occurring while attempting escape INFECTIVE AND PARASITIC DISEASE - EXAMPLE - RESPIRATORY DISEASE OR FOOD-POISONING STRAINS - RESULTING FROM PRE-EXISTING MUSCULOSKELETAL DISORDER (STRAIN OCCURS DURING SNEEZE) HOSPITALIZATION (OBSERVATION ONLY) Individual is hospitalized for observation not treatment. If treatment occurs (other than aspirin, non-prescription, it is reportable) ESCAPE FROM CUSTODY - INJURY OCCURRING WHILE ATTEMPTING ESCAPE Auto accident during high speed chase is not reportable. Accident involves criminal involvement.

26 NONREPORTABLE INJURIES / ILLNESSES
DEATH DUE TO NATURAL CAUSES - Example - heart attack ADVERSE REACTION- Reaction to alcohol or drugs not administered by medical authority PRE-EXISTING INJURIES OR ILLNESSES DEATH DUE TO NATURAL CAUSES - EXAMPLE - HEART ATTACK ADVERSE REACTION- REACTION TO ALCOHOL OR DRUGS NOT ADMINISTERED BY MEDICAL AUTHORITY PRE-EXISTING INJURIES OR ILLNESSES

27 CLASSIFICATION OF ARMY ACCIDENTS
Accident Type And Classification are used to determine: Notification requirements, Site security requirements, Investigation procedures and responsibilities, Required accident reports Notification procedures and investigation procedures depend on the extent of damage and injury. Serious accidents require immediate notification and may be investigated by a board appointed by the command. Aviation and ground accident have different notification, investigation and reporting requirements. You must understand Class A - F accident definitions to determine if you must immediately notify higher levels. When an accident meets the requirements for a board instigation, the unit is responsible to secure the accident site for the investigation board to look at. NOTIFICATION REQUIREMENTS, SITE SECURITY REQUIREMENTS, INVESTIGATION PROCEDURES AND RESPONSIBILITIES, REQUIRED ACCIDENT REPORTS AR , 2-2

28 CLASSIFICATION OF ARMY ACCIDENTS
CLASS A - an Army accident in which: The resulting total cost of property damage is $1,000,000 or more; An Army aircraft or missile is destroyed, missing, or abandoned; or An injury and/or occupational illness results in a fatality or permanent total disability. Class A is the most serious Army accident class and most be investigated by an appointed board for the USASC or the command. Class A criteria can be for amount of property damage or the degree of personnel injury. Property damage is total damage - military loss and damage to civilian property. Death or permanent disability - again applies to military personnel injuries, DA civilian on-duty, or non-Army personnel as a result of Army operations. Examples: A fire in an Army paint facility resulted in $1.2 M damage. A soldier was crushed by the rocket pod while performing maintenance on an MLRS. A soldier dove off a pier in shallow water breaking his neck and damaging his spine; resulting in a permanent total disability. AR , 2-2

29 CLASSIFICATION OF ARMY ACCIDENTS
CLASS B - an Army accident in which: The resulting total cost of property damage is $200,000 or more, But less than $1,000,000; An injury and/or occupational illness results in permanent partial disability, or When five or more personnel are inpatient hospitalized from a single occurrence. Class B is the next most serious Army accident class and must be investigated by an appointed board for the USASC or the command. Usually a local board is appointed. Class B criteria can be for amount of property damage (between $1M and $200K) or the degree of personnel injury. Property damage is total damage - military loss and damage to civilian property. Permanent partial disability - again applies to military personnel injuries, DA civilian on-duty, or non-Army personnel as a result of Army operations. Examples: Explosives detonated in an explosives press during work on an M67 grenade result in $350K damage to facility. A soldier was struck in the eye by a star cluster device fired by a nearby soldier. The accident resulted in permanent partial disability due to loss of sight in one eye. AR , 2-2

30 CLASSIFICATION OF ARMY ACCIDENTS NOTIFICATION, SECURITY, INVESTIGATION NOTE:
Class A & B accident investigations are conducted by an accident investigation board (CAI or IAI Board). Immediate notification is required through chain of command to USASC If possible, unit must secure the accident site for the accident board to see. (May not be possible for traffic accident) Class A & B accidents must be investigated by an appointed board for the USASC or the command. Notification is critical, so that a board can be appointed an arrive on site without undue delay. The supporting safety office will advise the unit on the feasibility of securing and maintaining the accident site for the board to see. Traffic accidents for example, normally can not be secured for a long period due to the traffic hazards created. AR , 3-2, 4-2

31 CLASSIFICATION OF ARMY ACCIDENTS
CLASS C - an Army accident in which: The resulting total cost of property damage is $10,000 or more, But less than $200,000; A nonfatal injury that causes any loss of time from work beyond the day or shift on which it occurred; Or a nonfatal occupational illness that causes loss of time from work (e.g. 1 work day) or disability at any time (lost time case). For example, a sports injury result in 1 lost day is a Class C accident. Also property damage accidents between $10K and $2K. Class C ground accident is investigated and reported by the unit. Class C aviation is investigated by 1 or more appointed officers. Examples: A HMMWV operator lost control on a wet road and rolled the vehicle resulting in $12,000 damage, but no injury to the operator. A soldier collided with another soldier during a touch football game and received a broken collar bone. He was unable to return to work the day of the injury and had quarters the following day. (1 lost work day). AR , 2-2

32 CLASSIFICATION OF ARMY ACCIDENTS
CLASS D - an Army accident in which: The resulting total cost of property damage is $2,000 or more, But less than $10,000. Example: An Army 5 ton truck backed into a parked civilian auto resulting in $2500 damage to the privately owned vehicle (as a result of Army operations). Note: An Army accident resulting in less than $ property damage and no lost time injury are reported using local procedures. Class D ground accident is investigated and reported by the unit. Class D aviation is investigated and reported by the local unit. AR , 2-2

33 CLASSIFICATION OF ARMY ACCIDENTS
CLASS E aviation incident - An Army incident in which the resulting damage cost and injury severity do not meet the criteria for Class A-D accident ($2,000 or more damage; lost time/restricted activity case). A Class E aviation incident is reportable when the mission is interrupted or not completed. AR , 2-2

34 CLASSIFICATION OF ARMY ACCIDENTS
FOREIGN OBJECT DAMAGE (FOD) AVIATION INCIDENT (CLASS F) - Recordable incidents are confined to aircraft turbine engine damage only as a result of internal or external FOD AR , 2-2

35 ARMY ACCIDENT TYPES ARMY AIRCRAFT ACCIDENT
ARMY MOTOR VEHICLE ACCIDENT (AMV) ARMY COMBAT VEHICLE (ACV) ARMY OPERATED VEHICLE OTHER ARMY VEHICLE PRIVATELY OWNED VEHICLE (POV) PERSONNEL INJURY - OTHER MARINE ACCIDENT FIRE CHEMICAL AGENT ACCIDENT EXPLOSIVES ACCIDENT IONIZING AND NONIONIZING RADIATION ACDT & INCIDENT NUCLEAR BIOLOGICAL DEFENSE MISHAP DRONE AIRCRAFT (RPV) FRATRICIDE There are several types of accidents described in AR Pam Some have special reporting requirements. Such as Fire, chemical agents, and radiation incidents… check specific requirements for types of accidents. PE # 1

36 COMMAND RESPONSIBILITIES PRELIMINARY ACCIDENT SITE PROCEDURES:
Initiate actions IAW unit pre-accident plan Contact emergency services - fire, rescue, MP, HAZMAT team, EOD Notification - chain of command First priority - safety of victims, personnel involved, and the general public As we’ve seen, notification procedures differ for the degree of damage or injury. Class A & B accident require immediate notification so a board can be appointed to investigate the accident. AR provides a step by step procedures for accident notification. AR AR , 2-9, 3-2

37 COMMAND RESPONSIBILITIES PRELININARY ACCIDENT SITE PROCEDURES:
Neutralize accident site hazards: Fire Ammunition cook-off / explosion Fuel spill / hazardous materials. Burnt carbon fibers (composite materials). Traffic hazards / additional collisions. Electrical hazards Bloodborne pathogen As we’ve seen, notification procedures differ for the degree of damage or injury. Class A & B accident require immediate notification so a board can be appointed to investigate the accident. AR provides a step by step procedures for accident notification. AR AR , 2-9, 3-2

38 COMMAND RESPONSIBILITIES PRELININARY ACCIDENT SITE PROCEDURES:
Take action to secure / preserve the accident scene Safeguard from bystanders Control access to site Rope off site - keep unauthorized personnel out Protect physical evidence - ground markings / scars, placement of wreckage / equipment SAFEGUARD FROM BYSTANDERS CONTROL ACCESS TO SITE ROPE OFF SITE - KEEP UNAUTHORIZED PERSONNEL OUT PROTECT PHYSICAL EVIDENCE - GROUND MARKINGS / SCARS, PLACEMENT OF WRECKAGE / EQUIPMENT AR , 2-9, 3-2

39 COMMAND RESPONSIBILITIES PRELIMINARY ACCIDENT SITE PROCEDURES:
Notify the commander of personnel involved Notify USASC, DSN /3410 (Class A & B (Avn / Gnd); & Class C Avn mishap) Notify USASC - (DA Civilian injuries - 3 or more hospitalized from a single accident - OSHA DOL notification) Provide information from Notification Worksheet DA Form 7306-R As we’ve seen, notification procedures differ for the degree of damage or injury. Class A & B accident require immediate notification so a board can be appointed to investigate the accident. AR provides a step by step procedures for accident notification. AR AR , 2-9, 3-2

40 COMMAND RESPONSIBILITIES INVESTIGATION / REPORTING RESPONSIBILITIES:
Commanders at all levels (installation level down to company or detachment) are responsible for investigating and reporting accidents. Class A & B On-duty - CAI / IAI board Class A & B Off-duty - Unit prepares AGAR / follow MACOM /installation procedures for fatal accidents. Class C & D - unit prepares AGAR Accident report submitted through chain of command / installation safety to USASC As we’ve seen, notification procedures differ for the degree of damage or injury. Class A & B accident require immediate notification so a board can be appointed to investigate the accident. AR provides a step by step procedures for accident notification. AR AR Table E-1 / E-2

41 ACCIDENT INVESTIGATION RESPONSIBILITIES - GROUND
ACDT CLASS RESPONSIBILITY REPORT CLASS A & B (NOTIFY USASC) DA ON-DUTY CAI / IAI BOARD TECH RPT CLASS A & B (NOTIFY USASC) AGAR OFF-DUTY MAY APPOINT IAI DAYS CLASS C & D UNIT CDR AGAR ON-DUTY DAYS CLASS A-D UNIT CDR AGAR OFF-DUTY DAYS This slide shows the responsibility and reporting requirements for ground accidents. This comes from the table in the back of AR This shows the PEACETIME reporting requirements DA CIVILIAN (CLASS A & B CA-1, CA-2 ON-DUTY NOTIFY USASC) CA-6 CLASS A & B CAI / IAI BOARD TECH RPT CLASS C SUPERVISOR CA-1, CA-2

42 ACCIDENT INVESTIGATION RESPONSIBILITIES - AVIATION
ACDT CLASS RESPONSIBILITY REPORT CLASS A (NOTIFY USASC) DA CAI / IAI BOARD TECH RPT CLASS B (NOTIFY USASC) DA CAI / IAI BOARD TECH RPT CLASS C (NOTIFY USASC) AAAR IAI BOARD DAYS This slide shows the responsibility and reporting requirements for aviation accidents. This comes from the table in the back of AR CLASS D - F UNIT CDR AAAR (PE # 2) DAYS

43 REPORTING vs. RECORDING ARMY ACCIDENTS
REPORTABLE ACCIDENTS (ALL ACCIDENTS) LOCAL REPORT PROCEDURES REPORTED TO UNIT SAFETY OFFICER OR INSTALLATION SAFETY AR REPORTED AND RECORDED IAW ARMY PROCEDURES All accidents are reportable to the unit and the installation safety office. All accidents are reportable. Minor accidents use local reporting procedures and notification. Accidents meeting the criteria in AR got Class A-F are recordable and require completion of the specific Army accident report form to report and record the accident. MINOR INJURY OR DAMAGE MEETS CRITERIA FOR RECORDABLE ACCIDENT / INCIDENT

44 REPORTING vs. RECORDING ARMY ACCIDENTS
REPORTING - Report all accidents to the unit safety officer / installation safety office Local reporting procedures for: Property damage less than $2000 Military personnel injury - no lost time / restricted duty only Military personnel injury - first aid only So REPORTING means - REPORT ALL ACCIDENTS TO THE UNIT SAFETY OFFICER / INSTALLATION SAFETY OFFICE Use LOCAL REPORTING PROCEDURES FOR: PROPERTY DAMAGE LESS THAN $2000 MILITARY PERSONNEL INJURY - NO LOST TIME / RESTRICTED DUTY ONLY MILITARY PERSONNEL INJURY - FIRST AID ONLY These minor accidents and near miss incidents can indicate safety hazards and problems that can be corrected before a more serious accident occurs.

45 REPORTING vs. RECORDING ARMY ACCIDENTS RECORDING - Meets AR criteria for recordable accident / incident. Investigation results are recorded on the appropriate form and forwarded to USASC for entry into Army accident database. Class A-D Accidents Class E & FOD Aviation Damage exceeds $2000 Soldier injury results in 1 or more lost workdays So RECORDING means that an accident - MEETS AR CRITERIA FOR RECORDABLE ACCIDENT / INCIDENT. INVESTIGATION RESULTS ARE RECORDED ON THE APPROPRIATE accident investigation FORM AND FORWARDED TO USASC FOR ENTRY INTO ARMY ACCIDENT DATABASE.

46 CATEGORIES OF ACCIDENT REPORTS
SAFETY ACCIDENT INVESTIGATION REPORT - Used for prevention purposes only Limited Use Report General Use Report COLLATERAL INVESTIGATION REPORT - Used to determine accountability, liability, claims, disciplinary action CRIMINAL INVESTIGATION (MP / CID) There are 3 types of accidents investigations that may be conducted for a single accident. The investigations are for different purposes. The SAFETY ACCIDENT INVESTIGATION REPORT is the focus of this training and is - USED FOR PREVENTION PURPOSES ONLY LIMITED USE REPORT GENERAL USE REPORT COLLATERAL INVESTIGATION REPORT - USED TO DETERMINE ACCOUNTABILITY, LIABILITY, CLAIMS, DISCIPLINARY ACTION CRIMINAL INVESTIGATION (MP / CID) AR , 2-9, 1-7

47 SAFETY ACCIDENT INVESTIGATION REPORTS Limited Use Safety Accident Investigation Report
All flight accidents Fratricide / friendly fire Selected accidents involving other complex weapons systems as determined by Cdr, USASC The limited use report is prepared by a CAI Board from the USASC. CDR, USASC determines that a limit use report is required… The difference is in how much of the report may be released to the public under a FOIA request. AR , 1-7

48 SAFETY ACCIDENT INVESTIGATION REPORTS Limited Use Safety Accident Investigation Report
Report is for accident prevention May offer confidentiality to witness Findings, recommendations, and witness statements not releasable to public or outside DoD Purely factual information - pictures, drawings, tests may be released / shared with collateral investigator All safety investigation accident reports are for prevention purposes… the information is used only to correct the problem not for disciplinary action… We will talk about the collateral report that is done for accountability in a few minutes.

49 SAFETY ACCIDENT INVESTIGATION REPORTS - AR , 1-7 General Use Safety Accident Investigation Report USE - To record data concerning all reportable accidents not covered by limited use reports. Used for accident prevention Not for administrative or disciplinary action within DoD Not generally releasable - need to know for the purpose of accident prevention Witness statements not exempt from disclosure in response to a request under FOIA The general use report is still only used for accident prevention purposed within Army and DoD…. The AGAR is a general use accident report. The general public can request CLASS D reports from the local JAG office/safety office. All other requests from the public / FOIA are referred to the USASC

50 COLLATERAL INVESTIGATION (NOT A SAFETY INVESTIGATION)
USE - Record facts for use in litigation, claims and administrative and disciplinary actions Required on all on-duty Class A accidents (LOD will suffice for off-duty fatality) Public Interest Safety personnel do not conduct, review, or store collateral investigations. Accident investigation has priority Collateral investigation covered by: AR or AR 15-6 At the same time that the safety investigation is going on… there is often a second investigation going on…. Often called the 15-6 investigation. The collateral investigation is used to determine accountability… if someone should be held responsible for the accident. This investigation is not governed by AR …but you need to be aware of it. AR , 1-8

51 CRIMINAL INVESTIGATION (MP / CID)
MP / CID - Investigate to determine if criminal activity is involved. Safety accident investigation board has access to MP / CID evidence, photos, witness statements Accident investigation will halt if criminal activity is discovered. (Other than negligence, dereliction of duty or disobedience of an order) The 3d type investigation that may be conducted is the criminal investigation… this is conducted if criminal activity is suspected. Example: A fuel line or break line is cut and sabotage is suspected. AR , 4-7

52 COMPLETING THE ACCIDENT REPORT DA PAM 385-40
Investigate / Report Army Accidents For Class A or B accidents an investigation board is appointed to determine : What happened, Why it happened, and What can be done to prevent reoccurrence. The CAI is conducted by the USASC for selected class A & B accidents. The IAI is appointed by the General Court Marshall authority for Class A & B accidents not investigated by a USASC CAI board. DA 285 Army Accident Report DA 285-AB-R Abbreviated Ground Accident Report

53 ACCIDENT INVESTIGATION AND REPORTING THE INVESTIGATION PROCESS:
WHY DID IT HAPPEN? SYSTEM INADEQUACY / ROOT CAUSE WHAT HAPPENED? CAUSE FACTORS WHAT TO DO ABOUT IT? RECOMMENDATIONS HUMAN ERROR / MISTAKE MATERIEL FAILURE ENVIRONMENTAL FACTOR The investigation seeks to determine… What happened Why it happened What to do about it SUPPORT LEADER TRAINING STDS / PROCEDURES INDIVIDUAL FIXES CONTROL MEASURES COUNTERMEASURES

54 ACCIDENT INVESTIGATION AND REPORTING
Example of a completed AGAR form, DA PAM , page PRACTICAL EXERCISE #3 The investigation seeks to determine… What happened Why it happened What to do about it

55 ACCIDENT INVESTIGATION AND REPORTING
Purpose of accident investigation Define Army accident Accident investigation responsibilities Classification of accidents Reporting and Recording Army accidents Categories of investigation reports Reporting Procedures- AGAR Accident reporting terminology These are the topic covered in today’s instruction. As safety officers / NCOs … you will be the ones that the commander and unit personnel turn to for advise on accident investigation and reporting

56 ACCIDENT INVESTIGATION AND REPORTING
QUESTIONS??

57 ACCIDENT INVESTIGATION AND REPORTING
PRACTICAL EXERCISE # 3 COMPLETING THE ACCIDENT REPORT FORM HOMEWORK DUE AT START OF CLASS IN THE MORNING.


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