OH NO Now What Do I Do

1
OH NO! Now What Do I Do?

• Accident Investigations
• Pamela A. Boatright, CIH
• University of Oklahoma
• Health Sciences Center

2
What is an Accident?

• An accident is any unplanned event that results
  in personal injury or in property damage.

3
Why Investigate?

• Accident investigation concentrates on gathering
  all information about the factors leading to an
  accident.
• The goal is preventing future accidents and
  injuries.

4
Why Investigate?

• Determine direct causes
• Uncover contributing causes
• Prevent similar accidents
• Document facts
• Provide information on costs
• Promote safety

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Determine Direct Causes

• Hazard control system failure?
• Rules and regulations broken?
• Defective machinery?
• Poor layout of workspace?

6
Uncover Contributing Causes

• Other factors may be
• Poor housekeeping
• Failure to follow maintenance schedules
• Inadequate supervision
• Faulty equipment

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Prevent Similar Accidents

• Identification may help prevent similar accidents
  in the future by identifying needed actions and
  improvements.

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Document Facts

• Compensation and litigation issues
• A permanent record of facts
• Accident reconstruction may be needed
• Facts must be recorded properly, accurately and
  thoroughly

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Provide Information on Costs

• Direct Costs
• Indirect Costs

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Promote Safety

• Psychological and material benefits
• Demonstrates the organizations interest
• Indicates managements sense of accountability
  and commitment to safety
• Fact-finding, not Fault-finding process

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Be empathetic

• Treat employees with respect
• People do not like pain
• Do not make assumptions
• Be sensitive to the fact that the injured party
  may be embarrassed and defensive
• Seek to fix the problem, not the blame

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Cases to be Investigated

• All on-the-job injuries, exposures or illnesses
  should be reported
• Near-misses may hold important clues about
  potential accidents and should be reported also

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Accident Causes and Their Control

• Every accident can be attributed, directly or
  indirectly to
• Human factors (the worker or another person)
• Situational factors (facilities, tools,
  equipment, or materials)
• Environmental factors (noise, vibration,
  temperature extremes, illumination)

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Human Factors

• Any person who by action or failure to act causes
  an accident
• deviation from standard operating procedures
• deviation from safety rules and training
• WHY??

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Why?

• No safe job procedures exist
• The employee did not know the standard job
  procedure
• Employee knew, but did not follow the procedures
• Employee followed procedures

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Why?

• Procedure encourages risk-taking
• Employee changed the job procedure or by-passed
  safety procedures
• Employee did not follow procedures because of the
  supervisor
• Individual characteristics

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Situational Factors

• Hazardous Materials
• Unsafe operations
• Tools
• Equipment
• Facilities

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Environmental Factors

• Physical - noise, vibration, radiation, lighting,
  temperature
• Chemical - toxic gas or vapors, fumes, mists,
  smoke
• Biological - bacteria, fungi, parasites, insects,
  plants
• Ergonomic - awkward or repetitive actions that
  place stress on the body

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Sources of Situational or Environmental Hazards

• Purchasing agents
• Maintenance personnel
• Employees

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Examining Accident Causation

• After-the-fact
• Before-the-fact
• Critical Incident Technique
• Safety Sampling

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After-the-fact

• Crucial Questions
• Who?
• How?
• What?
• Why?
• When? (and following sequence)
• Where?

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Eight Data Elements

• Employer data
• Employee data
• Narrative Description
• Equipment

• Task description
• Time Factors
• Nature of Injury
• Preventive Measures

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Fact-Finding

• Interview witnesses as soon as possible,
• Inspect the accident site before any changes
  occur.
• Take photographs and make sketches.
• Record pertinent data in maps.
• Get copies of all reports.
• Keep accurate notes in a bound notebook.

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Fact-Finding

• Documents containing normal operating procedures,
  flow diagrams, maintenance charts, or reports of
  difficulties or abnormalities may be useful.
• Record pre-accident conditions, the accident
  sequence, and post-accident conditions.

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Fact-Finding

• Document the location of victims, witnesses,
  machineryk, energy sources, and hazardous
  materials.
• Call in experts if needed.

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Interviews

• Get preliminary statements as soon as possible
  from witnesses.
• Locate the position of witnesses on a map or
  chart.
• Explain the purpose (prevention) and try to put
  the witness at ease.
• Let the witness speak freely and take notes
  without distracting him/her.

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Interviews

• Use a tape recorder only with the permission of
  the witness.
• Use sketches and diagrams to help the witness.
• Make note of direct observations versus hearsay.
• Try to use the exact words used by the witness.

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Interviews

• Word questions carefully and repeat or reword if
  the witness does not undestand the question.
• Identify the qualifications of each witness
  (name, address, occupation, years of experience,
  etc.).
• Supply each witness with a copy of their
  statements (signed statements desirable).

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Before-the-fact

• Systematic approach to identifying and evaluating
  an accident before it occurs
• Critical Incident Technique
• Safety Sampling

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Critical Incident Technique

• Ask a sampling of workers to describe job hazards
• Management classifies incidents into hazard
  categories and identifies problem areas
• A team can analyze the management systems in
  place that should have prevented the unsafe acts
  or conditions

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Safety Sampling

• Uses expertise within the organization
• Make rounds to observe unsafe practices
• Make observations during different times of the
  day and throughout the jobsite

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Resources and References

• http//www.osha.gov/
• http//www.cdc.gov/niosh/homepage.html
• http//www.cdc.gov/
• http//atsdr1.atsdr.cdc.gov8080/
• http//www.epa.gov/enviro/index_java.html
• http//ace.ace.orst.edu/info/extoxnet/
• http//www.nsc.org/