Accident Investigation Report PDF Version


Farm Safety Association, Inc.

To ensure that no information relating to the accident is overlooked, it is important to have some type of accident report form on which to record data. This form can be a standard form supplied by safety specialists or one developed specifically for your own company or operation.

Although there is a distinct difference between an accident investigation report and the investigation itself, the two are so closely associated that management uses the form to determine that an investigation has been held and to evaluate the quality of the supervisor's work. Evaluations of investigation reports in certain large organizations form part of each department's accident-prevention performance rating. An evaluation of an individual supervisor's report forms can be used to determine his or her accident-prevention rating as part of an annual performance review.

Investigation report forms are also required by law in some cases. Government and insurance officials sometimes request and examine them; and courts may subpoena them for evaluation in cases of liability .Supervisors and their managers also use them to manage remedial action. Many organizations require executive-level officials to conduct major reviews or hearings following accidents and incidents of a serious nature. The supervisor's accident or incident investigation report form becomes a focal point of attention and a guide to further discussions.

These are some of the reasons why the proper completion of an investigation report has important implications for the supervisor.

Supervisor's Accident Investigation Report provided courtesy of IAP A

MORE EFFECTIVE ACCIDENT CONTROL

 
Through Good
  
INVESTIGATION
and
REMEDIAL ACTION
BY APPLYING THESE OBJECTIVES
  1. To determine all contributing causal factors.
  2. To determine the fundamental or basic reason for the existence of each contributing factor.
 
  1. To eliminate or control each contributing cause.
  2. To eliminate or control the reason for the existence of each contributing cause.
AND FOLLOWING THESE GUIDEPOSTS
  • In case of injury, make sure worker is properly cared for before doing anything else
  • When practical, have scene kept as undisturbed as possible
  • Investigate as promptly as possible
  • Whenever possible, go to scene of accident for initial investigation
  • As applicable, have someone else get photographs; make drawings or measurements
  • Interview all witnesses, one at a time and separately
  • Reassure each witness of investigations real purpose
  • Get witnesses initial version with minimal interruption; ask for complete version step by step; have him describe and point without doing
  • Apply empathy in interviews; make no attempt to fix blame or find fault
  • Be objective; don't have fixed opinion in advance
  • When witness finishes initial explanation, ask questions to fill in gaps
  • Avoid questions that lead witness or imply answers wanted or unwanted
  • Summarize your understanding with witness after interview
  • Express sincere appreciation to anyone who helped in the investigation
  • Record data accurately
  {Select appropriate actions)
  • Institute formal training program
  • Give personal reinstruction
  • Institute Proper Job Instruction Program
  • Temporarily or permanently reassign person/s
  • Institute a job analysis program
  • Order job analysis on specific job/s
  • Revise existing job analysis
  • Institute a job observation program
  • Order job observation on specific job/s
  • Institute new or improve existing inspection program
  • Institute pre-use checkout of equipment
  • Establish or revise indoctrination for new or transferred employees
  • Repair or replace equipment
  • Improve design of equipment
  • Establish design requirements for new equipment
  • Improve basic design or establish design standards
  • Improve identification or color code for safety
  • Install or improve safeguards
  • Eliminate unnecessary material in area
  • Institute program of order or improve clean-up
  • Institute mandatory protective equipment program or improve existing coverage or design
  • Use safer material
  • Establish purchasing standard/s or controls
  • Institute incident recall program
  • Create safety incentive program
  • Improve physical examination program
WILL REDUCE
INJURIES & DAMAGE
DEFECTS & DELAYS
REJECTS & REWORK
MISTAKES & WASTE

ACCIDENT INVESTIGATION CHECKLIST

WHO?
  • Who was involved? Who is he/she? What was he doing at the time? Was it his job? Since when? Was he trained for it?
  • Who else was there? Who are they? What were they doing?
  • Who saw what happened? Who heard it? Who reported it?
WHAT?
  • What equipment was involved? What was it doing/being used for at the time? Was this a normal use?
  • What was its condition (use/abuse, maintenance, etc.)? Was this a usual condition? Was it properly guarded?
  • What materials were involved? What were they being used for? Was this a proper use for them?
  • What known hazards do they have (toxicity, radiation, sharp, etc.)? If hazards exist, were the materials being used/handled properly?
WHERE?
  • Where did it happen in the plant/shop?
  • What was the Environment like? What was the layout? .
  • What was the condition of the workplace/site at the time? (Floor -housekeeping -traffic -lighting -noise -distractions -temperature, etc. )
  • Where did it occur in the flow of operation? Where in the Production Line? Where were the people (identified in "WHO" above) positioned relative to the occurrence?
WHEN?
  • When was it reported? When did it occur in the working day? On what day/date?
HOW?
  • How did it happen/ How can you be sure? Can you use the answers to these questions to produce a detailed description.
  • Are the answers clear enough?
  • Do you need to repeat or rephrase any questions?
  • Do you need to ask more questions?
WHY?
  • Evolves from all these questions.
This information is provided by:
FARM SAFETY ASSOCIATION INC.,

The information and recommendations contained in this publication are believed to be reliable and representative of contemporary expert opinion on the subject material. The Farm Safety Association does not guarantee absolute accuracy or sufficiency of subject material, nor can it accept responsibility for health and safety recommendations that may have been omitted due to particular and exceptional conditions and circumstances.

Disclaimer and Reproduction Information: Information in NASD does not represent NIOSH policy. Information included in NASD appears by permission of the author and/or copyright holder. More

Reviewed for NASD: 08/2003