effective accident investigation
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TRANSCRIPT
EFFECTIVE ACCIDENT INVESTIGATION
Yawar Hassan Khan
INTRODUCTION
YAWAR HASAN KHAN CERTIFIED HSE MANAGEMENT
PROFESSIONAL ASSISTANT SAFETY OFFICER- ACL
What is an accident
An accident is the final event in an unplanned process that result in injury or illness to an employee and possibly property damage
Accident types
STRUCK BY STRUCK AGAINST CONTACT BY CONTACT WITH CAUGHT ON CAUGHT BETWEEN FALL TO SURFACE FALL TO BELOW OVER EXERTION BODILY REACTION OVER EXPOSURE
CAUSE OF ACCIDENT
Old theory-worker error :says worker makes a choice to work in an unsafe manner
New theory-system approach : says accidents occur due to multiple causes and due to defects in the systems
Characteristics of effective incident investigation program Clearly assigned responsibility for accident
investigation All accident investigations will be formally
trained on accident investigation techniques The purpose is to find fact not fault Dig deep to know hazardous conditions that
caused accidents report will make the recommendations to
correct the hazardous conditions and work practices
Corrective actions must be completed An annual review of accident reports
Six steps for conducting accident investigation
Secure the accident scene Conduct interview Develop the sequence of events Conduct cause analysis Determine the solutions Write the report
DOCUMENTING THE ACCIDENT SCENE
Make personal observations Take photos of accident scene Take video clips of the scene sketch the accident scene Interview records
Steve’s seven rights of interview process
Be sure you ask the Right people the Right question at the Right time in the Right place in the Right way for the Right reason to uncover the Right facts
WHO NEEDS TO BE INTERVIEWED
The victim Co workers Direct supervisors Manager Training department Personnel department Maintenance department Emergency responders Medical personal Coroner Police The victim’s spouse and family
Effective interviewing techniques
Keep the purpose of investigation in the mind
Approach the investigation with an open mind
Go to the scene Express concern regarding the accident
and desire to prevent a similar occurrence
Tell the interviewee that the information they give is important
Be friendly , understanding and open minded
Be calm and unhurried
Single event theory
An accident is thought to be the result of a single , one time easily identifiable , unusual , unexpected occurrence that result in injury or illness
The domino theory
This describes as a series of related occurences which lead to a final event that results in injury or illness
Multiple cause theory
Accidents are a result of a series of random related and / or unrelated actions that somehow interact to cause the accident
Four categories of events
Actual events Assumed events Non events Simultaneous events
Developing the sequence of events
Once the sequence of events is developed we will study each event to know:
Hazardous condition Unsafe behaviors System weaknesses
Components of an event
Actor: the actor is an individual or object that directly influenced the flow of the sequence of events
Action is something that is done by the actor
Hazardous conditions
Materials Machinery Equipment Tools Chemicals Environment Workstations Facilities People workload
Levels of cause analysis
Injury analysis Event analysis System analysis
Higher priority strategies that control hazards
Elimination Substitution Engineering controls
Lower priority strategies to control exposure and behavior
WARNINGS ADMINISTRATIVE CONTROLS PERSONAL PROTECTIVE EQUIPMENT
WRITING THE REPORT
Background Description Findings Recommendations Summary
THANK YOU
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