Accident Investigation
Core Concepts to Review
Accident Investigation should be part of every loss control system. Effective investigations can
1)Describe what happened
2)Determine the root cause
3)Develop controls
4)Define trends
5)Demonstrate management’s concern
Line supervisors or leaders should conduct most investigations
1)They have a personal interest in the people and workplace involved.
2)They know the people and conditions
3)They know how best to get the information needed.
4)They are the ones who implement most remedial actions.
5)They are held accountable for what happens in their areas. Staff personnel & Higher level managers take part in major loss cases and those where specialized knowledge is needed.
Reasons why people may not report accidents:
1)Fear of consequences
2)Concern about the safety record
3)Lack of understanding or the importance of complete reporting.
Basic ways to get better reporting are to:
1)Communicate
2)Educate
3)Train employees on the need for reporting and why it is so critical
4)Enact in a positive way to timely reporting
Following are 6 major phases of effective investigation, with key guidelines for each:
1)Respond to the emergency promptly and positively
a)Take control of the scene
b)Ensure first aid and call 911
c)Control potential secondary accidents
d)Identify sources of evidence at the scene
e)Preserve evidence form alteration or removal
f)Investigate to determine loss potential
g)Decide who should be notified
2)Collect pertinent information
a)Get “the big picture” first
b)People evidence – interviewing
- interview witnesses separately
- interview on-site when possible
- Put the person at ease
- Get the individual’s version (listen don’t interrupt)
- Ask questions at the right time
- Give feed back to the witness for understanding
- Record information in notes
- Use visual aids
- Use reenactment carefully
- End on a positive note
- Keep communication lines open
c)Don’t reenact the accident unless absolutely necessary and with great caution
d)For capture position evidence, use sketches, maps, or photos to show relative position before and after details
e)Collect and safeguard important parts such as equipment, tools, damaged areas and fluid samples
f)Examine records to identify basic causes such as training, maintenance, or scheduling problems.
3)Analyze and evaluate all significant causes.
a)use the cause and effect sequence
b)Make a causal factor outline
c)Cover immediate causes
d)Determine the critical few specific causes
e)Cover the deficiencies in the management system
4)Develop and take remedial action
a)Consider alternative controls
b)Lower likelihood of occurrence
c)Reduce the potential severity of the loss
d)Take temporary actions immediately
e)Document in written report
5)Review findings and recommendations
a)Have every report reviewed by the next higher level manager
b)Measure the quality of the report
6)Follow Through
a)Conduct investigation review meetings
b)Monitor timely implementation of prevention actions
c)Analyze data for trends
d)Profit from prompt and positive changes based on the review