DON Mishap and Hazard Reporting Matrix

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DoD Mishap Class - A Minimum of or expected to reach $2 million in property damage, or Fatality, or Injury or Occupational related illness causing Permanent Total Disability (PTD) or expected Fatality or PTD Active Duty On - duty / On - base 6 B Death 1 st GO & SIREP in SIREP in A 4 On - duty / Off - base 6 B A 4 Off - duty / On - base 6 B A 4 Off - duty / Off - base 6 B A Fed. Civ. Employees On - duty / On - base 6 A 4 On - duty / Off - base 6 A 4 Off - duty / On - base 4 Off - duty / Off - base Contractors On-base - under Direct supervision of DoD personnel A 4 Off-base - under Direct supervision of DoD personnel A 4 Under supervision of Contractor personnel Caused by military activity or 6 Family members, guests, other civilian On-base - caused by Military activity or Off-base - caused by Military activity or On-base - not caused by military activity or s Off-base - not caused by military activity or s Property Damage (Minimum of or expected to reach cost of $2 million) 6 6 DoD property caused by military activity 6 DoD property caused by civilian or contractor activity Non-DoD property caused by military activity Combined cost of DoD & Non-DoD property caused by military activity Non-DoD property caused by non-dod civilian or contractor A 4 A 4 A 4 6 6 6 4 4 4 4 1

DoD Mishap Class - B $00,000 to $1,999,999 in property damage, or Hospitalization of 3 or more personnel in the same mishap, or Injury or Occupational related illness causing Permanent Partial Disability (PPD) (This includes an on-duty, occupationally related, acute, traumatic hearing loss) Active Duty On - duty / On - base 6 On - duty / Off - base 6 Off - duty / On - base 6 Off - duty / Off - base 6 Fed. Civ. Employees On - duty / On - base 6 On - duty / Off - base 6 & Off - duty / On - base 6 & ref a Death 1 st GO & SIREP in SIREP in 4 4 4 4 4 4 Off - duty / Off - base Contractors On-base - under Direct supervision of DoD personnel Off-base - under Direct supervision of DoD personnel 6 6 4 4 Under supervision of Contractor personnel & Caused by military activity or 4 6 Family members, guests, other civilian On-base - caused by Military activity or Off-base - caused by Military activity or On-base - not caused by military activity or s Off-base - not caused by military activity or s Property Damage (Minimum of or expected to reach cost of $00,000 6 6 DoD property caused by military activity DoD property caused by civilian or contractor activity Non-DoD property caused by military activity Combined cost of DoD & Non-DoD property caused by military activity Non-DoD property caused by non-dod civilian or contractor 4 4 4 4 4 4 2

DoD Mishap Class - C $0,000 to $499,999 in property damage, or occupational related illness or injury causing a minimum of (1) lost workday beyond day of injury, including weekends, or an individual off-duty military injury causing a minimum of (1) lost workday beyond day of injury, including weekends. (Lost workdays include; SIQ for 24 hours or more, Hospitalization beyond the day of mishap, Mishap related con-leave) Active Duty Death Brief to 1 st GO & SIREP in On - duty / On - base 4 On - duty / Off - base 4 Off - duty / On - base 4 SIREP in Off - duty / Off - base Fed. Civ. Employees On - duty / On - base 4 On - duty / Off - base 4 Off - duty / On - base 4 Off - duty / Off - base Contractors On-base - under Direct supervision of DoD 4 personnel Off-base - under Direct supervision of DoD 4 personnel Under supervision of Contractor personnel Caused by military activity or 4 Family members, guests, other civilian On-base - caused by Military activity or Off-base - caused by Military activity or On-base - not caused by military activity or s Off-base - not caused by military activity or s Property Damage (Minimum of or expected to reach cost of $0,000) 4 4 DoD property caused by military activity 4 DoD property caused by civilian or contractor activity Non-DoD property caused by military activity Combined cost of DoD & Non-DoD property caused by military activity Non-DoD property caused by non-dod civilian or contractor 4 4 4 3

DoD Mishap Class - D $20,000 to $49,999 in property damage, or injury or occupational illness resulting in medical treatment beyond 1st Aid. This includes: LIGHT DUTY, LIMITED DUTY, a loss of consciousness, restricted days away from work for federal civilians, any medical removal under medical surveillance requirements of an OSHA standard, needle stick injuries or cuts from sharps that are contaminated from another person s blood or other potentially infectious material, a prolonged occupational related hearing loss, or occupationally related tuberculosis exposure. Active Duty Death Brief to 1 st GO & SIREP in On - duty / On - base 4 On - duty / Off - base 4 Off - duty / On - base 4 SIREP in Off - duty / Off - base Fed. Civ. Employees On - duty / On - base 4 On - duty / Off - base 4 Off - duty / On - base 4 Off - duty / Off - base Contractors On-base - under Direct supervision of DoD 4 personnel Off-base - under Direct supervision of DoD 4 personnel Under supervision of Contractor personnel Caused by military activity or 4 Family members, guests, other civilian On-base - caused by Military activity or Off-base - caused by Military activity or On-base - not caused by military activity or s Off-base - not caused by military activity or s Property Damage (Minimum of or expected to reach cost of $20,000) 4 4 DoD property caused by military activity 4 DoD property caused by civilian or contractor activity Non-DoD property caused by military activity Combined cost of DoD & Non-DoD property caused by military activity Non-DoD property caused by non-dod civilian or contractor 4 3 4 4 4

NOTES: 1. A Safety Board (SIB) is required for - Hospitalization, beyond observation, of 3 or more personnel, (at least 1 of who is a DoD civilian), involved in a single mishap. (see Chapter 6 of OPNAVINST 102.1D / MCO P102.1B) 2. A Safety Board (SIB) is required for - All explosives related mishaps, all ordnance impacting off range, and all live fire mishap resulting in an injury. (see Chapter 6 of OPNAVINST 102.1D / MCO P102.1B) 3. In special cases, Chief of Naval Operations (CNO (N09F)) or Commandant of the Marine Corps, Safety Division (CMC (SD)) may direct an independent safety investigation. These independent investigations do not relieve commanders of their responsibilities for safety investigation and reporting as required by OPNAVINST 102.1D / MCO P102.1B. 4. A is to be submitted when the elimination and control of a given has community-wide implication in reducing mishaps. Providing information on problems with widespread relevance will help reduce mishaps.(see Chapter 4 of OPNAVINST 102.1D / MCO P102.1B). If the, injury, illness, or property damage resulted from military activity, then see note 6 for immediate notification requirements, see notes 1, 2, & 3 for SIB requirements, see reference A for 8-day & death brief requirements and see reference B for 7-day brief requirements. 6. Notify COMNAVSAFECEN, of all mishaps that result in the hospitalization of three or more personnel, within eight hours of the mishap by telephone or electronic means. Notify CMC(SD), the chain of command, and COMNAVSAFECEN of all other on-duty DoD civilian and all on and off-duty military fatalities regardless of cause (suicide, homicide, medical, etc.) within eight hours by electronic means. (see Chapter 3 of OPNAVINST 102.1D / MCO P102.1B) REFERENCES: A. MCO 100.29B, Marine Corps Safety Program, 28 July 2011 B. OPNAVINST 102.1D/MCO P102.1B, Chapter 1 C. MCO 100.34A, Deadline Safety of Use Message Instructions to Suspend Operations of Marine Corps Ground Equipment and Weapons Systems, Safety of Use Message and Maintenance Advisory Messages, 19 June 2017 All Commanders, Commanding Officers, and Officers-In-Charge shall: - Report all potential s associated with the operation of Marine Corps ground equipment and weapons systems. - Individuals may report potential s to MARCORSYSCOM Safety at MCSC_Safety@usmc.mil and/or to Commandant of the Marine Corps Safety Division (CMC SD) at hqmc_safety_divison@usmc.mil. - Identify and report situations that negatively affect safety of operation via the Automated Message Handling System to: COMMARCORSYSCOM OOT QUANTICO VA; PEO LS QUANTICO VA SAFETY; CMC SD WASHINGTON DC; CMC WASHINGTON DC PPO; CMC WASHINGTON DC I&L; COMNAVSAFECEN NORFOLK VA. D. MARADMIN 8/16, Eight Day Brief Requirements, Oct 2016 E. MARADMIN 672/16, Change to MARADMIN 8/16, Dec 2016

DoD and DON Other Safety Reportable Events (Active Duty, On-Duty Federal Civilian Employee, or on-duty contractor under direct supervision of DON personnel) All GMV or GVO mishaps resulting in $000 or more in government vehicle or government property damage; or a mishap caused by operation of a GMV/GMO which results in $000 or more total damage to non-government vehicle and/or property damage, Any parachuting, HRST, or cargo airdrop mishap (regardless of severity of injury or damage) Death 1 st GO & SIREP 6 4 6 4 SIREP All on-duty diving cases involving the Central Nervous System (CNS), oxygen toxicity, Pulmonary Over Inflation Syndrome (POIS), or hyperbaric treatment. 6 4 Any high or moderate risk training mishaps that result in the loss of one training day, rolling back or disenrollment of the student from a course. (regardless if it meets severity) 6 4 Any on-duty military heat stress or cold injury requiring medical treatment. Individual Injury or occupational related illness with NO lost work time. (See Glossary 1, paragraph 43 and 44 for definition of First-Aid (page G1-14) 6 4 4 If class D Events or fatalities that are not mishaps per the DoD or DON. These are Non-Safety reportable events. Yet, they require the command to use some of the same reports as used by safety. Death 1 st GO & SIREP SIREP Homicide (committed against a service member or on-duty federal civilian) ( 6) A Suicide (Military only) ( 6) Suicide Attempt ( military only) Unintentional death due to use of an illegal drug (Military only) Injury or fatality in the act of escaping or evading law enforcement. (Military only) ( 6) ( 6) A D & E A A 6

Safety Reportable Events as a S: In addition to current requirements for S, the following specific events are considered a near-miss and are highly recommended to be reported via for the purpose of capturing ous conditions or processes that require review or intervention by major supporting commands (e.g. Systems Command, Training and Education Command, Facilities Command, etc.) Loss of consciousness from submersion during water based training (e.g. Recon screening/indoctrination, water survival training, etc.) Any Parachute related malfunction that does not cause injury or damage. Brief to Death Brief to 1 st GO & SIREP SIREP 3 3 C 3 3 Any failure of a bilge pump on any amphibious vehicle (e.g. AAV, LAV, etc.) that does not result in damage or injury. Any unintentional occupationally related chemical exposure without hospitalization. Any inadvertent release of HALON in any government owned vehicle system or government owned workspace without injury or damage. Any inadvertent explosion, fire, or chemical release of any government owned battery that did not cause injury, Illness, or property damage (e.g. Lithium batteries). Any GMV or GVO mishap (crash, rollover, etc.) without injury. Any minor GMV or GVO related mishap not meeting minimum reportable cost or injury threshold where the driver/operator stated his/her vision was restricted during operation. Any inadvertent operation of GMV/GVO functions (seats, turrets, braking, accelerator, hatches) due to placement of actuating levers or switches that are incompatible with movement of the operator or personnel. Any braking system or electrical failure on any GMV/GVO not resulting in a reportable injury or property damage. Any electrical shock that did not result in the medical treatment to any on or off duty DoD personnel that occurs at a Navy or Marine Corps owned facility or from Navy-Marine Corps owned equipment. Any electrical shock that did not result in any medical treatment or injury/fatality and to a family member or guest caused by any electrical source at a Navy or Marine Corps owned facility or from Navy-Marine Corps owned equipment. Any malfunction of any Navy-Marine Corps weapons system or ordinance that does not cause injury or damage. Any cracks or unusual wear, tear, or damage to ordnance received from the ASP. C 3 3 3 3 C 3 3 C 3 3 3 3 C 3 3 C 3 3 C 3 3 C 3 3 3 3 C 3 C 3 7

Safety Reportable Events as a S: In addition to current requirements for S, the following specific events are considered a near-miss and are highly recommended to be reported via for the purpose of capturing ous conditions or processes that require review or intervention by major supporting commands (e.g. Systems Command, Training and Education Command, Facilities Command, etc.) Any unintentional explosion or explosive release of energy without injury or reportable damage. This includes all pressurized systems or ordnance on any Navy-Marine Corps equipment, vehicle systems, shipboard systems or in facilities Brief to Death Brief to 1 st GO & SIREP SIREP C 3 3 Any on-duty, occupationally related heat stress injury without hospitalization, lost time, or light duty (e.g. heat exhaustion or heat cramps or heat syncope). Any slip, trip, or fall of any individual (military, Federal employee, or visitor) that occurs in any government owned facility as a result of a controllable, yet does not result in medical treatment. Any failure of DoN owned recreational equipment or machinery that causes injury or illness to any human (regardless of severity of injury) that occurs on an installation, whether it is stationary for public use or temporarily issued or rented. Any unexpected malfunction of any DoN owned equipment or components used in the movement or transportation of materials or personnel that does not cause injury or damage. 3 3 3 3 3 3 C 3 3 8

The following s are required to be reported as a to the Naval Safety Center and/or CMC (Safety Division) OPNAVINST 102.1D/ MCO P102.1B, Chapter 4: A is an unsafe act or condition, such as a flaw in established work procedures; training deficiency, or the design, manufacture, or use of a piece of equipment with the potential to cause injury or damage. A report () is intended to be submitted when the elimination and control of a given has community-wide implication in reducing mishaps. Providing information on problems with widespread relevance will help reduce mishaps. Commanders, commanding officers, and officers-incharge should ensure investigation and submission of a on ous conditions or near-mishaps that may affect other commands but do not warrant submission of a SIREP. NOTE: The does not replace a SIREP for reportable mishaps. A or near-mishap and the recommended remedial or corrective action taken to eliminate the. A previously unrecognized so that another agency may determine appropriate corrective action to eliminate the. A significant, unexpected, or unusual occupational overexposure, as the result of industrial hygiene assessments of industrial processes or operations, to bring that potential exposure to the attention of medical and safety authorities and others. Electrical shock incidents where the mishap did not result in any medical treatment or injury/fatality and where it was determined that the shock was caused by equipment design. Afloat man overboard mishaps while underway where the mishap did not result in a recordable/reportable injury/fatality. Any other unusual discovered during maintenance, repair, inspections, or evolutions where notifying other activities may prevent future mishaps. If Safety Board (SIB) discovers a unrelated to the mishap that warrants immediate widespread dissemination, the unit will prepare and submit the. If a Safety Board (SIB) discovers a that warrants immediate widespread dissemination, the senior member will prepare and submit a. CMC SD Message 16 April 2014 - units shall notify CMC(SD) and MARCORSYSCOM for all; On-Duty ground mishaps involving tactical equipment, weapon systems, or tactical vehicles. This includes, but not limited to Injury, Fatality, or DoD Property Damage. MCO 100.34A, 19 Jun 2017- All Commanders, Commanding Officers, and Officers-In-Charge shall: Report all potential s associated with the operation of Marine Corps ground equipment and weapons systems. Individuals may report potential s to MARCORSYSCOM Safety at MCSC_Safety@usmc.mil and/or to Commandant of the Marine Corps Safety Division (CMC SD) at hqmc_safety_divison@usmc.mil. MARCORSYSCOM and affiliated PEOs shall issue DSOUM, SOUM, and/or MAM to: suspend operations, provide instructions for limited use, or communicate safety related information. Take necessary actions in accordance with DSOUM, SOUM, and/or MAM. During combat operations, General Officer level commanders and forward deployed Marine Expeditionary Unit (MEU) commanders may continue operation of suspended equipment after a documented Risk Management assessment, per reference (d), determines that continued use is a necessary and accepted risk. Adhere to the directions and action(s) contained in DSOUM, SOUM, and/or MAM. Identify and report situations that negatively affect safety of operation via the Automated Message Handling System to: COMMARCORSYSCOM OOT QUANTICO VA; PEO LS QUANTICO VA SAFETY; CMC SD WASHINGTON DC; CMC WASHINGTON DC PPO; CMC WASHINGTON DC I&L; and COMNAVSAFECEN NORFOLK VA. 9