Presented by Joe Angyus, CSP October 7, 2009 Easy Incident & Accident Investigations

Three Common Myths 1. Accidents, by definition, “just happen” 2. Many accidents are caused by “stupidity” 3. No accidents = safe workplace

Establish an investigation process Determine what to investigate; Who will investigate; and Write policy on investigation procedure “Those designated simply have to take the time, understanding that, in the long run, inadequate investigations will cost them even more time” –Frank Bird, Jr., Practical Loss Control Leadership

Reporting incidents Employees who: Fear Have concern Want to avoid Misunderstand Won’t report! But when employees: Buy in Perceive importance See the value Believe in end goal They’re more likely to report!

Phases of Investigation 1. Initial actions at the scene 2. Gather information (Four P’s) 3. Analyze all significant causes 4. Develop and take corrective actions 5. Write the report 6. Review the findings and recommendations 7. Follow up to verify effectiveness of the actions

Initial actions at the scene Take control Ensure first aid, call emergency services Control secondary incidents Identify sources of evidence Preserve evidence Determine loss potential Notify personnel

Gathering Information Interviewing witnesses (people) Photos, sketches, or maps (positions) Equipment exam (parts) –Material failure analysis Records check (paper)

Write a good description Description should contain: 1.What was the injured attempting to do? 2.What went wrong? 3.What was the outcome (loss)? Be thorough, but keep it simple!

Writing a good description 1. What was the injured attempting to do? The injured was attempting to replace a defective air valve by using a 12 ft. step ladder.

Writing a good description 2. What went wrong? Since it was leaning unsecured against the air receiver tank, the ladder slipped outward as the injured climbed to access the valve.

Writing a good description 3. What was the outcome (loss)? The injured fell 7 ft. to the floor beneath the tank, striking against hydraulic lines causing a fractured left collarbone and significant bruising to his right arm and shoulder.

Analyze significant causes Start with the event (loss) Work backwards by asking “why” Identify the unsafe acts/conditions Don’t stop at “symptoms” Determine system failures

Take immediate corrective actions At the scene With the people involved By the frontline leader Examples: –Re-instruct the injured –Replace the tool

Take long-term corrective actions Identify and correct system deficiencies Types of system deficiencies could include: –Standards for tools and equipment selection, use and inspection –Training program –Employee observation –Management controls

Review the findings and recommendations Management’s role in investigation process: –Demonstrates importance –Verify problems solved –Determine who else needs to know –Identify why the safety program didn’t adequately control the hazard

Follow up to verify action effectiveness Evaluate how systems are working after actions taken Circle back with injured employee

Questions? ? ? ? If you have further questions, please contact: –Joe Angyus ~ –