How Can Near Misses be Used to Improve Your Safety Program? We Work Safely

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1 How Can Near Misses be Used to Improve Your Safety Program? Matt Shurtliff, CSP Director of Safety and Environmental Issues J.D. Heiskell & Co. 1

2 Before We Start If you re unsure of a safe way to do a job No task is worth getting hurt! 2

3 What is a Near Miss? An unplanned event that did not result in injury, illness, or damage but had the potential to do so.

4 What Is a Near Miss? You could have gotten hurt, but you didn t

5 Safety Severity Pyramid 21% of Lower Level Incidents could have been SIFs Fatalities Serious Injuries OSHA Recordable & First Aid Injuries 21% Near-Misses & Property Damage Hazards & Behaviors

6 We Want To Find The 21% These are Uncontrolled High Risks We want to control them before someone gets hurt badly 21%

7 Why Do I Need a Near Miss Reporting System? Most SIF incidents are preceded by warnings or near miss incidents. Recognizing and reporting near misses can prevent them

8 SIF Case Study: Winter in Maine

9 SIF Case Study

10 SIFCase Study

11 Case Study

12 SIF - Basic Facts Several Feet of snow in week prior Frequent freezing & thawing Heavy snowfall on day of accident Worker came out door and slipped on ice Head struck concrete wall 12

13 SIF - Facility History You know, several of us have slipped there before Each slip was a NEAR MISS If we had reported and acted, we could have prevented this SIF 13

14 Starting a Near Miss Reporting System

15 Good Resource

16 Establish a Reporting Culture Teach employees WHY you want to know about Near Misses Make it EASY to report Make it SAFE to report o Nobody gets in trouble o Anonymous if desired Consider Incentives Communicate Results

17 Tips: When You Find The Risk Address as if the injury had occurred: Determine root causes Take Corrective Action o Temporary what we do NOW o Permanent Use Hierarchy of Controls o Higher risks need better controls

18 Challenges to Implementation Companies must overcome the employee s fear of being blamed after reporting a near miss

19 (Jan 2016) We Have A Cultural Hurdle People don t want to look BAD This plays out many ways o Reluctance to look for problems o Defensiveness o Rationalization we ve just had some crazy things happen o Blaming the easiest target

20 (Jan 16) Fear of Losing Face Everybody who s taken this journey has faced this issue It kills continuous improvement It prevents us from reaching the goal we ve set for ourselves

21 (Jan 16) How To Clear The Hurdle We ve already said we need to change We ve already admitted the problems are out there Our goal should be: o Find them o Fix them We need to foster this attitude

22 JDH Strategy To Address Hurdle Coach employees Show them it s safe to report Consider Incentives o Gift card o Tiered pay Communicate progress broadly o Recognize and thank the employee o Show that risk is addressed

23 Near Miss Reporting

24 Near Miss Reporting

25 Near Miss Reporting

26 Near Miss Reporting

27 Our Experience Reporting near misses provides HIGH VALUE We see more problems before they cause injuries We have identified and reduced SIF potential We see better Risk Awareness We learn how deep our culture has reached

28 Role of Near Misses in Our Program

29 JDH Safety Vision Safety is Managing Injury RISK We Manage Injury Risk Like Any Other Risk To Our Business oidentify oquantify oreduce unacceptable risk

30 We ID Risk SEVERAL WAYS Proactive o HazID Walks o Near Miss Reports o Facility Self-Audits o Employee Interviews o Safety Committees o Task Hazard Analyses o SLAM o Behavior Observations (coming in 2019) Reactive o Property Damage o Vehicle Accidents o Injury Investigations

31 We Manage All Risks the SAME WAY o Score risk o Determine Corrective Action o Assign Owner o Track to completion We Have ONE LIST for all of our Corrective Actions

32 Risk Management Process Severity = how bad will injury be Likelihood = how likely is it to happen Risk = Severity x Likelihood Risk Threshold

33 Risk Response Plan - SIF Risks Notify GM STOP WORK Immediate temporary CA Develop & install permanent CA Risk Threshold

34 Risk Response Plan Permanent CAs for o Risk > 6 o Severity 4 regardless of likelihood Temporary CAs as Needed Risk Threshold

35 Reducing Risk Goal PERMANENT solutions Use Hierarchy of Controls to guide our actions For SIF Risks we want Level 1 Controls

36 Hierarchy of Controls Eliminate hazard or risk Level 1 Substitute MOST EFFECTIVE Engineering Controls Isolate, Guard, Modify Level 2 USE WITH OTHERS Administrative Controls Behavior SOPs, Best Practices, Rules Training Level 3 LEAST EFFECTIVE PPE

37 Reducing Risk Level 1 Controls MOST Effective First Choice Best Strategy Eliminate or prevent creation of hazard If you can t do that: Substitute (less dangerous, toxic, etc.) Engineering Controls)

38 Engineering Controls Purpose: Eliminate or reduce contact between people and hazard. Modify/redesign equipment or work process Change configuration of existing machinery Change traffic flow Install new machinery Machine guarding Reduce magnitude of hazard Dust collection systems Dust suppression systems

39 Reducing Risk Level 2 Controls Low Effectiveness More effective in combination with other controls Requires more effort & dollars to maintain/sustain Examples: Signs and labels Policy & procedures Re-Training

40 Why is Level 2 Less Effective? You are relying on signs, rules, procedures, and plans These only work if employees know that you re serious about them ONLY way to show you re serious o Train employees on the rules and procedures o Inspect what you expect frequently o Correct behavior when controls aren t followed 40

41 Reduce Risk Level 3 Least Effective when used by itself. Last resort strategy. Provide PPE & keep in easily accessible location. Requires consistent training & reinforcement. Includes (not limited to): Hearing, vision, skin, respiratory protection Fall protection Other

42 Why is Level 3 LEAST Effective? I can t remove the risk, wear this so you don t get hurt Need to make sure employees o Know HOW to use the PPE o ALWAYS use IT o Know when it needs to be replaced Need to always have it available It s much better to not need PPE at all 42

43 Core Risk Reduction Process Self- Auditing Near Miss Reports SIF Hazard Investigation Task Hazard Analysis Employee Interviews Property Damage Hazard ID Walks Ability to SEE risk is critical to our success Corrective Actions Vehicle Accidents Injuries

44 Developing Risk Recognition Skills Safety Guy Plant Mgrs Supervisors Front Line

45 Value of Risk Recognition Skills More eyes see more risk Front Line KNOWS where the risk is Awareness increases Tolerance decreases Peers teach peers Everyone

46 Questions? Matt Shurtliff, CSP J.D. Heiskell & Co