Metro-North Railroad Guide for Incident Reporting

Metro-North Railroad Guide for Incident Reporting Revised March 2017

MTA Metro-North Railroad Safety Policy Statement Metro-North Railroad recognizes that safety is the most critical element of our operation. We are committed to complete and accurate reporting of all accidents, incidents, injuries, and occupational illnesses arising from the operation of the railroad, to full compliance with the letter and spirit of the Federal Railroad Administration s accident reporting regulations. The harassment or intimidation of any person that is calculated to discourage or prevent such person from receiving proper medical treatment or from reporting such accident, incident, injury or illness will not be permitted or tolerated and will result in disciplinary action against any employee committing such harassment or intimidation. Working together as a cooperative team we will achieve Metro-North s safety goals and enhance the safety of our railroad. As employees, it is our responsibility to take ownership of our own safety and the safety of others. It is through the implementation of the System Safety Program Plan, that we identify safety responsibilities and how we are accountable throughout the organization, providing a safe, healthy working environment for our employees and a safe, comfortable environment for our customers and the public. As safety is the most important factor in the performance of duties, it is vital that every employee puts safety first, follows safety rules and work procedures, and uses sound judgment while performing their job. Complaints relating to an accident or injury are to be submitted in writing to the Vice President, System Safety describing in detail the date, time, witnesses (if any), and the nature of the incident giving rise to the complaint. If you have any questions in relation to this statement, please contact the Office of System Safety on the Safety Help Line: (212) 340-3131 or email: MNRSafetyConcerns@mnr.org

Table of Contents Section 1 Introduction Page 1.1 Purpose... 1 2.1 Definitions... 1 3.1 Relevant Contacts... 3 Section 2 Incident Reporting and Investigation 2.1 Immediately Following Incident... 4 2.2 Transportation of Injured Employees... 4 2.3 Initial Report of Incident (IR-1)... 4 2.4 Documenting Incident Site... 5 2.5 Medical Evaluation... 5 2.6 Medical Evaluation Considerations... 6 2.7 Incident Investigation Report (IR-2)... 7 Section 3 Responsibilities 3.1 Employee(s) Involved in an Incident... 9 3.2 Immediate Supervisor... 9 3.3 Lead Investigator (Department)... 10 3.4 Department Lead... 10 3.5 Operations Control Center Delay Clerk... 10 3.6 Occupational Health Services Department... 11 3.7 Office of System Safety... 11 3.8 Claims Services Department... 11

List of Appendices A- Incident/Injury Flowchart B- Initial Report of Incident (IR-1) C- Incident Investigation Report (IR-2) D- Employee/Witness Statement Form E- Employee Post Incident Instructions F- 15 Day Report G- Request for Occupational Health Services (MD-40)

Section 1 Introduction 1. Purpose The purpose of this guide is to provide a framework for managers and supervisors to carry out reporting and investigating workplace incidents. When an incident is reported in an accurate and timely manner, corrective actions can be identified and implemented to prevent reoccurrence. As a result of conducting a complete, detailed incident investigation, Metro-North Railroad (MNR) will create a safer work environment by: Identify the causal factors that contributed directly or indirectly to an incident. Identify deficiencies in systems, practices, and procedures. Utilize information to eliminate potential accidents, incidents, and injuries. Identify root cause(s) and implement corrective actions. Identify trends or areas of concern. Accurately track injury rates. Comply with regulatory reporting requirements. 2. Definitions Contributing Factor(s) - The factor(s) that contributed to an event or condition but, by itself, would not have caused the incident. Corrective Action(s): Measures taken to improve upon or resolve identified undesirable situations and prevent them from reoccurring. Federal Railroad Administration (FRA): The regulatory agency that develops and enforces railroad safety regulations, carries out investigations, analyzes railroad accidents and conducts safety assessments of railroads. Incident: Any unplanned occurrence or condition arising from railroad operations or the actions of employees or other persons, which results, or may result, in injury or illness to person(s) or damage to property. Injury: Harm to a person resulting from a single event, activity, occurrence, or exposure of short duration. Investigation: A detailed, systematic search for and review of facts in order to determine the "who, what, where, when, why, and how" of an incident or near miss, and to determine what corrective actions can be instituted to prevent reoccurrence. IR-1: Metro-North Initial Report of Incident. 1

IR-2: Metro-North Incident Investigation Report. (Alternative Railroad-Designed Record to form FRA F 6180.98) Lost Time (Days away from work): The count of days away from work due to a work related injury or illness, including all calendar days, regardless of whether the injured employee would normally be scheduled to work. The count starts on the first calendar day after the injured employee has been examined by a physician or other licensed health care professional and continues until the injured employee returns to work. Medical Evaluation: A process that involves examination by a qualified health care professional that may involve non-invasive diagnostic procedures for the purposes of determining the nature and extent of injury. Medical Treatment: The care of an injury or illness by a qualified health care professional. Near Miss: Any unplanned event or condition arising from railroad operations or the actions of employees or other persons, which, under slightly different circumstances, would have resulted in injury or illness to person(s) or damage to property. The near miss event should be used as an opportunity to improve safety by learning from an incident that had the potential for more serious consequences. Non-Reportable: Injuries requiring no medical treatment beyond what is considered as First Aid in accordance with 49 CFR Part 225. Occupational Illness: Any abnormal condition or disorder that is not the result of any injury, but appears to be caused by environmental factors associated with an employee s occupation and employment within MNR, such as: contact dermatitis, poison ivy, respiratory conditions to a toxic agent, heatstroke, heat exhaustion or a noise-induced hearing problem. Regular Work Location: The location an employee routinely reports to for MNR purposes. Reportable Incident: Incident connected with the operation of the MNR that must be reported to the FRA because it meets the reporting threshold mandates. These include injury to an employee who needs medical treatment beyond first aid, receives a puncture wound from a medical sharp, is losing time or is placed on restricted duty for one day or more, and any occupational illness diagnosed by a physician. Restricted Duty (Days Restricted): When an employee is unfit to perform their normal routine job function or their normal work hours. 2

Root Cause(s): The immediate event(s) or condition(s) that caused an incident, which if had been previously corrected, would more than likely have prevented the incident Supervisor(s): Agreement and Non-Agreement employees with direct reports that are not supervisors. Work Related: An event or exposure in the work environment discernably causing or contributing to a resulting condition, or if an event or exposure occurring in the work environment is a discernable cause of a significant aggravation to a preexisting injury or illness. 3. Relevant Contacts Name/Organization Telephone Fax MNR Occupational Health Services (212) 499-4720 (212) 499-4740 MNR Office of System Safety (212) 340-2328 MNR Claims Services (212) 340-2032 (212) 340-4820 MNR Operations Control Center (212) 340-2050 (212) 340-3310 MNR Employee Assistance Program (212) 340-2792 MNR Legal Affairs (212) 340-4933 (212) 697-9079 MTA Police (888) 682-9117 (888) MTA-911PD 3

Section 2 Incident Reporting and Investigation Prompt reporting will initiate the incident notification process to ensure that the investigation will be adequately documented and that critical evidence will be preserved. An accurate and in-depth investigation will assist in determining the root cause(s) of an incident and allow for the implementation of appropriate corrective actions. The investigation also enables the MNR Claims Services (Claims) and Occupational Health Services (OHS) Departments to manage any medical evaluation and treatment more effectively. The investigation process is outlined in the IR-1 and IR-2 Flowcharts located in Appendix D of this document. 1. Immediately Following Incident A supervisor s first responsibility is to assist in providing prompt, appropriate first aid or emergency medical treatment for any person injured in an incident. If emergency medical treatment is requested or necessary, emergency medical responders must be contacted and tend to the injured employee(s) at the scene or the employee(s) must be promptly transported to the closest appropriate hospital or medical facility. A supervisor or designated responsible employee must accompany the injured employee(s) to the hospital or medical facility. In extreme cases, refusal of medical treatment must be made to responding medical professional. 2. Transportation of Injured Employees Emergency medical transportation must be summoned to transport severely injured employees for medical treatment. Company vehicles may only be used to provide transportation for minor medical evaluation and/or treatment. Under no circumstances may an employee s request for medical treatment or transportation to a hospital or medical facility be denied. If transportation to a hospital is requested by an employee, the railroad shall promptly arrange to have the employee transported to the nearest hospital where they can receive safe and appropriate medical evaluation and/or treatment. 3. Initial Report of Incident (IR-1) After ensuring medical attention to any injured employee(s), the supervisor must identify and document any relevant information at the incident site, as well as complete an IR-1 for each employee involved in the incident. Either immediately following an incident, or while others are providing prompt medical attention, but no later than the end of the shift of the Person Notified, the completed IR-1 must be submitted to the Operations Control Center (OCC) by email or fax. If there will be a delay due to lack of access to the form or a fax machine, provide the information to the OCC by telephone. 4

Operations Control Center Email: MNRChiefsDesk-Safety@mnr.org Phone: (212) 340-2050 or 2051 Fax: (212) 340-3310 Changes or revisions are not to be made to any IR-1. If there is inaccurate information provided on the IR-1, the IR-2 can be used to clarify or make changes as necessary. 4. Documenting Incident Site Identify and document any relevant information about the incident site as soon as possible. Note weather and environmental conditions, any equipment in the area and include weight and height of objects or tools when possible. Take relevant photos and, when appropriate, sketch the incident site. Any information that could affect the investigation should be recorded before any changes to the site take place. In special cases when possible, cordon off area with caution tape to preserve relevant information. It is also recommended to get employee and other witness statements as soon as possible after the incident has occurred. 5. Medical Evaluation After ensuring proper medical treatment for any injured employee(s) and documenting the incident site, the supervisor must arrange for an initial medical evaluation of the injured employee(s) by OHS or, if necessary, by a Physician or Other Licensed Health Care Professional (PLHCP) designated by MNR. If the injured employee(s) receives emergency medical evaluation and treatment, and the treating health care professional confirms that the employee is fit for duty, relevant paperwork must be sent to OHS and medical evaluation by OHS is not necessary. An employee is required to cooperate with a reasonable request to appear for a medical evaluation. However the evaluation must be scheduled in a manner that does not interfere with, or delay, an employee s medical treatment plan or doctor s orders. If a supervisor is in doubt as to how to handle a situation wherein the employee objects to a medical evaluation, he or she should seek guidance from their supervisor or from OHS. An initial medical evaluation must be conducted when an injured employee: 1. cannot complete his/her tour of duty, or; 2. cannot perform the assigned duties of his/her position, or; 3. suffers an injury including, but not limited to, the following type: o any injury to the neck, back, shoulder or knee o any injury to the eye(s), eye area, or ear(s) o head trauma 5

o o o o severe bleeding any loss of consciousness electric shock incident of a nature or severity that appears to be inconsistent with the circumstances of the incident If the employee declines medical treatment, supervisors may authorize exceptions to the requirement for an initial medical evaluation. Exceptions to a requirement for an initial medical evaluation are acceptable when the injuries are minor (e.g. minor cut, abrasion, bruise, or insect bite), and the circumstances of the incident are clearly established and consistent with the nature of the injury. If it is determined that an evaluation is not required, the Employee Post Incident Instructions (Appendix G) must still be completed. 6. Medical Evaluation Considerations Scheduling an Appointment with OHS If an injured employee is to have an initial medical evaluation by OHS, the supervisor must coordinate with the Department s Employee Availability Specialist or assigned administrator who must notify and confirm with OHS that the employee is coming for medical evaluation. Documentation The supervisor must complete Part 1 of the Request for Occupational Health Services Form (also referred to as MD-40, included as Appendix F), give a copy to the injured employee, and instruct the employee to present the form to OHS. If the employee is sent to OHS directly from a field location where an MD-40 may not be available, the supervisor should contact OHS to advise them of this situation. Following the initial medical evaluation, OHS will document the results (fit for duty; not fit for duty; applicable restrictions; etc.) on the MD-40 and give a copy to the employee. The employee must present the completed MD-40 to the supervisor prior to returning to work duty. Copies of the completed MD-40 must be submitted to the Office of System Safety by OHS upon receipt. Evaluation and/or Treatment Outside of MNR If an injured employee is evaluated or treated outside of MNR and is judged by a PLHCP to be fit for work duty, with appropriate documentation, it is not necessary for the employee to be evaluated by OHS. The employee must submit documentation to OHS, who will then immediately inform the supervisor whether the employee is fit for duty. If a supervisor has a question regarding an employee s status, he or she may contact OHS. 6

If an injured employee is evaluated outside of OHS, and is judged not fit for full duty, a follow up appointment with OHS must be scheduled by their Department. This enables OHS to effectively monitor the employee s recovery, rehabilitation and return to work status. 7. Incident Investigation Report (IR-2) A required and critical step in the incident investigation process is to prepare and submit an IR-2. The IR-2 form may be accessed through the intranet under Departments Office of the President Office of System Safety Incident/Injury Management. Upon its completion, an electronic copy of the report must be submitted within seven (7) days after the incident to: IR2@mnr.org. If there are any questions regarding the preparation of an IR-2 contact the Office of System Safety should be contacted. The IR-2 should be completed using the information preserved at the incident site and discovered during interviews of involved employees. The following items are required to be included in the report: Identify root cause(s) and contributing factor(s) Identify corrective actions, the person(s) and department responsible for their implementation, and completed/or expected completion date Identify incident location, date, and time Identify injured employee(s) and direct supervisor, along with their employee number Identify type of incident Identify and interview witnesses List notification date and time Identify the injury or illness and the affected body part, if applicable Describe the incident in detail Sketch the incident site, if applicable Describe property damage, if applicable Describe spills, if applicable Describe weather conditions at time of incident Identify if employee(s) were engaged in normal job duties Identify if the task being performed required special training or qualifications Identify if a Job Safety Briefing (JSB) was held prior to starting work Describe PPE worn by employee(s) at time of incident 7

The Initial Report of Incident (IR-1), and the Incident Investigation Report (IR- 2), satisfy an FRA reporting requirement and therefore, every section must be completely and accurately filled out without exception. The IR-2 must be forwarded to the Office of System Safety no later than seven (7) days after the date of the incident. If completion of the report is delayed, notify the Office of System Safety immediately for further instruction. All investigative materials must be preserved. If the investigator identifies a broken or defective tool involved in the incident, for example, that tool must be preserved as service allows. Do not destroy any photographs, notes, drawings, or other materials created or collected during the investigation. A copy of the IR-1 originally sent to the OCC must be included with the completed IR-2 when submitting it to the Office of System Safety. The following items must also be submitted with the IR-2 package: Employee Statement Witness Statement(s) Post-Injury Instructions 15 Day Report Pictures (if applicable) Request for Occupational Health Services (MD-40) It is highly encouraged to send any additional medical or hospital documentation and/or a copy of the Job Safety Briefing (JSB) used the day of the incident with the IR-2 package. Participation in an investigation is mandatory and failure to do so is considered an act of insubordination. The employee labor agreement does not exclude any employee from participating in an investigation or giving a statement. It is not required, however, for any employee to be photographed for the purpose of the reenactment, and if necessary, the supervisor completing the report can use actor(s) in the photographs to fill in for the employee(s) involved. The Office of System Safety is available to review draft IR-2 s prior to their final submission to ensure accuracy and quality, and to assist in the reporting process. Please do not send the reports to the Field Safety Officers directly. Submit any draft IR-2 s to IR2@mnr.org and indicate that the IR-2 is a draft and that a review is requested. If an IR-2 needs corrections, a designated Office of System representative will conduct a follow-up. 8

Section 3 Responsibilities The following outlines the responsibilities of all individuals who may be involved in the incident investigation process. 1. Employee(s) Involved in an Incident Any employee involved in an incident is responsible for: a. Seeking and/or administering medical attention for injured person(s). b. Reporting the incident to his/her direct supervisor immediately. c. Following supervisor s instructions concerning an initial medical evaluation in the case of an injury or illness. d. Providing documentation of any and all medical evaluations associated with a work-related incident to OHS. e. Returning to the incident site to provide information necessary to the incident investigation and report as soon as reasonably possible. f. Participating fully and cooperating with person(s) conducting the investigation to provide complete, accurate, and timely information. 2. Immediate Supervisor The immediate supervisor of an employee involved in an incident is responsible for: a. Ensuring prompt and appropriate medical treatment or assistance to any injured person(s). b. Ensuring appropriate transport of injured person(s) to the nearest hospital or emergency medical facility. c. Identifying and documenting any relevant information at the incident site, as appropriate. d. Photographing and securing, where possible, any defective tools or other physical objects involved and preserving any and all photographs taken during the investigation. e. Completing an MNR Initial Report of Incident form (IR-1) and transmitting information as directed, as soon as possible, but not later than the end of their shift. f. Contacting the department lead to determine their lead investigator. g. Notifying injured employee(s) of the need for OHS documentation if a medical evaluation is performed by anyone outside of MNR. 9

h. Assisting the lead investigator, as appropriate, in conducting the incident investigation and determining and executing corrective actions as established by the investigation. 3. Lead Investigator (Department) The Lead Investigator shall be determined by the Department Head, and is responsible for: a. Contacting the Office of System Safety to review and assist in the incident investigation process. b. Meeting with person(s) involved in the incident, at the incident site if necessary, to initiate the incident investigation using the MNR Incident Investigation Report Form (IR-2) based on review with a representative from the Office of System Safety. c. Reviewing the incident reporting and investigation process details with appropriate, affected person(s). d. Analyzing, in conjunction with the Office of System Safety, as appropriate, the facts and determining root cause(s) and contributing factor(s) of the incident. e. Completing an IR-2 and submitting to department lead for review and signature. 4. Department Lead The Department Lead must be above the Immediate Supervisor and is responsible for: a. Assigning the lead investigator when notified of incident. b. Reviewing and approving a completed IR-2. c. Submitting a completed and signed IR-2 to the Office of System Safety within seven (7) days of incident. d. Assigning a representative to present and discuss the incident and findings at the Incident Safety Review. e. Ensuring implementation of any corrective actions, as described in the IR-2. 5. Operations Control Center Delay Clerk The Operations Control Center (OCC) Delay Clerk is responsible for: a. Immediately, upon receipt of the IR-1, paging the Injury Group with a brief notification of the incident (excluding name and employee number). b. Immediately faxing a copy of the IR-1 to the Office of System Safety and OHS. c. Including the IR-1 in the Daily Operations Report. 10

6. Occupational Health Services Department The Occupational Health Services (OHS) Department is responsible for: a. Providing timely appointments for post-incident evaluations of injured employees. b. Timely evaluation and reporting employees fitness for duty status. c. Managing employees back to full duty in coordination with treating medical professionals, the employee s department, and Claims. d. General medical case management guidance. e. Forwarding all medical information received to the Office of System Safety. 7. Office of System Safety The Office of System Safety is responsible for: a. Participating in incident investigations, either directly or by review of the report, as deemed appropriate. b. Reviewing the incident investigation documentation to ensure it is complete. c. Periodically auditing investigation process to ensure all departments follow these guidelines. d. Providing technical support for the investigation as needed, (e.g. conducting exposure monitoring, hazard assessments, regulatory review). e. Reporting all incidents to external agencies, such as the Federal Railroad Administration (FRA), as required. 8. Claims Services Department The Claims Services Department is responsible for: a. Reviewing all incoming injury and occupational illness cases. b. Coordinating post injury management. c. Tracking injured employees work status. d. Forwarding all medical information received to the Office of System Safety. 11