INCIDENT INVESTIGATION PROGRAM 1.0 PURPOSE The purpose of this program is to prevent the recurrence of an incident and to eliminate or minimize the risks associated with the incident. 2.0 SCOPE This procedure will lead the investigating team through the process of determining event sequence leading to the incident, identification of the root cause(s), and determining corrective action(s) to prevent the incident from recurring. 3.0 DEFINITIONS Incident - An unplanned and unwanted event that results in personal injury, illness, loss of life, or in property damage. Incident prevention - Plans, preparations and actions taken to avoid or stop an incident before it happens. Program Administrator - The individual responsible for planning, implementing, and evaluating the program effectiveness. 4.0 REQUIREMENTS DECISION POINT Customize All Text in Red 4.1 RESPONSIBILITIES A. Program Administrator. Enter Position Title is the program administrator and has the authority and responsibility for implementing the provisions of this program. 1 P a g e
B. Managers and supervisors are to: Provide a workplace free from recognized hazards and comply with governmental standards, rules and regulations. Provide safety training, where required and maintain records of persons safety training. Provide personal protective equipment where required. Make sure persons have and use safe tools and equipment and properly maintain this equipment. Provide access to Safety Data Sheets for hazardous chemicals used in the workplace. Use color codes, posters, labels or signs to warn persons of potential hazards. Establish or update operating procedures and communicate them so that persons follow safety and health requirements. Investigate work-related injuries and illnesses for root causes and take prompt corrective actions to prevent recurrence. C. Employees are to: Attend all required safety training. Read and understand the Safety Data Sheet (SDS) and know the hazards and safe work practices for all of the chemicals that you work with. Know the emergency and evacuation procedures, and the location of emergency equipment. Act in a professional manner, keeping in mind their own personal safety and the safety of others at all times. Maintain personal work area and common areas in a clean and orderly manner. Wear the appropriate Personal Protective Equipment (PPE) required for their job tasks. Warn and notify your supervisor and other persons of any malfunctioning equipment, hazardous conditions, and unsafe behavior in the workplace. Report all incidents and near misses to campus Security. 2 P a g e
Report a job-related injury or illness and seek appropriate treatment. 4.2 INCIDENT PREVENTION CRITERIA Workplace incidents are preventable. Many incidents occur due to human factor errors. This includes unsafe acts, un-mindfulness, negligence, lack of knowledge and training. Another leading factor of incident is unsafe working conditions. This Program Administrator and company managers and supervisors must be vigil for any unsafe acts and working conditions by persons that have the potential to cause harm and or property and equipment damage. Incident prevention requires the following actions: Hazard identification by risk assessment Removal of unsafe work conditions Removal of unsafe machines and tools Improvement of working conditions and environments 4.3 INCIDENT INVESTIGATION FORMS The company s incident investigator is to select from the Appendix, one of the following incident investigation forms based on the type of incident that occurred and is to be investigated: Injury & Illness Incident Report Form Vehicle Accident & Property Damage Report Form Bloodborne Pathogens Exposure Incident Investigation Form 3 P a g e
4.4 INCIDENT INVESTIGATION PROCESS Enter Position Title has established an incident investigation process which must be adhered to for the following incidents: Occupational Injury Fatality Property Damage Permanent Disabling Injury Vehicle Damage Occupational Illness A. General Guidelines The incident investigation process has established first and second level notification tiers and investigation team members. B. Methodology Used Our company has established the following methods to ensure incidents are thoroughly investigated, corrective countermeasures are taken and lessons learned are recognized and distributed to prevent recurrence: Root Cause Analysis and Countermeasures 1) Identify Root Cause 2) Identify System Failure 3) Assign Countermeasures Tracking Countermeasures 1) Assign Accountable Persons for each countermeasure 2) Assign Due Dates 3) Escalation Process Lessons Learned 1) Operations Morning Meeting 2) Emails XYZ Company s Incident Reporting forms are in the Appendix. 4 P a g e
4.5 INVESTIGATION FACT FINDING PROCEDURES Enter Position Title has established the following fact finding procedures that must be followed: 1. Interview witnesses as soon as possible after an incident. 2. Inspect the incident site before any changes occur. 3. Take photographs of the incident scene. 4. Record all pertinent data on maps/diagrams. 5. Get copies of all reports. 6. Retrieve documents containing normal operating procedures, flow diagrams, maintenance charts, or reports of difficulties or abnormalities if available. 7. Keep complete and accurate notes in a notebook. 8. Record pre-incident conditions, the incident sequence, and post-incident conditions. 9. Document the location of victims, witnesses, machinery, energy sources, and hazardous materials. 10. In some investigations, a particular physical or chemical law, principle, or property may explain a sequence of events. Include laws in the notes taken during the investigation or in the later analysis of data. In addition, gather data during the investigation that may lend itself to analysis by these laws, principles, or properties. An appendix in the final report can include an extended discussion. 4.6 INVESTIGATION INTERVIEW PROCEDURES Enter Position Title has established the following interviewing procedures for the investigation team: 1. Appoint a speaker for the group. 2. Get preliminary statements as soon as possible from all witnesses. 3. Locate the position of each witness on a master chart (including the direction of view). 4. Arrange for a convenient time and place to talk to each witness. 5. Explain purpose of the investigation (incident prevention) and put each witness at ease. 6. Listen, let each witness speak freely, and be courteous and considerate. 5 P a g e
7. Take notes without distracting the witness. Tape recorder only with witness consent. 8. Use sketches and diagrams to help the witness. 9. Emphasize areas of direct observation. Label hearsay accordingly. 10. Be sincere and do not argue with the witness. 11. Record the exact words used by the witness to describe each observation. Do not "put words into a witness' mouth." 12. Word each question carefully and be sure the witness understands. 13. Identify the qualifications of each witness (occupation, years of experience, etc.). 14. Supply each witness with a signed copy of their witness statement. Post Interview Procedures: Analyze each witness' statement. Team members may wish to re-interview one or more witnesses to confirm or clarify key points. Analyze this information along with data from the incident site. 4.7 INCIDENT REPORT PROCESS Enter Position Title has established an incident report for the investigating incidents. (See Attachment - Incident Report Form) The process includes completing the following report sections: 1. Security Initial Responder a. Narrative b. Actions Taken 2. Person Involved a. Name/Job Title b. Incident Date/Shift Start Time/Incident Time c. Company Name (if not an SG employee) 3. Investigation Team a. Team Member Name b. Team Member Job Title 4. Incident Detail 6 P a g e
5. Witness detail 6. Root Cause Analysis Process Tool 5.0 PROGRAM FORMS 1. Bloodborne Pathogens Exposure Report 2. Injury & Illness Incident Report 3. Vehicle Accident & Property Damage Report 5.1 RELATED SAFETY PROGRAM Injury & Illness Prevention Program 6.0 PROGRAM REVISION RECORD Date Revision # Change Made Author (s) 0 Major Rewrite 7 P a g e
APPENDIX Copies of blank incident investigation report forms are to be kept in this appendix. 8 P a g e