PROGRAM NUMBER NO. PAGES 09-001 7 REVISION ISSUE DATE 6/12/2014 09/03/2009 SAFETY AND HEALTH PROGRAM Incident Investigation Procedures 1.0 PURPOSE The purpose of this document is to provide specific guidelines for the timely reporting and investigation of all accidents involving property damage or injury of Penn State Office of Physical Plant (OPP) employees as well as near miss incidents. 2.0 SCOPE This program applies to OPP employees responsible for reporting and/or investigation of injuries and illnesses and accidents involving property damage. It is also encouraged that near misses also be investigated and reported to the OPP Safety Office to prevent a more serious outcome in the future. 3.0 PROCEDURES FOR INVESTIGATION OF INCIDENTS Immediately upon notification of any non-serious injury of an employee while performing job duties, any accident resulting in significant damage to OPP property or equipment, and/or any near miss incident that could have resulted in injury or property damage, the manager/supervisor of the injured employee should: 3.1 Ensure all injured employees receive necessary medical attention. 3.2 Ensure that accident scene is secure and does not pose a hazard to other personnel in the area. 3.3 Gather as much information as possible from the accident scene, injured employees and witnesses. 3.4 Take pictures 3.5 For all injuries, compete and submit a First Report of Injury, through the Sedgwick Management System located at https://sedgwickcms.claimcapture.com/. Upon completion, complete an OPP Workers' Compensation Signature Packet located at http://ohr.psu.edu/assets/workers-compensation/forms/oppsignaturepacket.pdf 3.6 For near miss incidents, complete an Incident Investigation Form (see Appendix A) located at http://www.opp.psu.edu/intranet/hr/safety-and-workers-compentsation-information/forms- 1/incident-investigation-form/incident-investigation-form/view and return it to the OPP Safety Office (103 OPP, oppsafety@psu.edu ) as soon as possible following the event.
The INCIDENT INVESTIGATION should determine the following: The cause(s) of the accident or injury. The relevant events leading up to the accident / injury. Unsafe conditions which contributed to the accident/injury. Actions of the employee which contributed to the accident / injury. Witnesses to the accident / injury. Recommendations to prevent a similar accident / injury from recurring in the future. Actual procedures used in an investigation depend primarily on the nature of and the results of the accident. The investigator should use the following steps as a guide to conducting a thorough accident investigation: 3.7 Gather and review details of the accident including but not limited to: Description of the accident, with damage estimates Normal operating procedures. Location of the accident site. List of witnesses. Events that preceded the accident. 3.8 Inspect the actual accident site as soon after the accident as possible. If necessary, secure the area. Do not disturb the scene unless a hazard exists. Take necessary sketches, photographs, and video of the area or activity if necessary. Label all items carefully and keep accurate records. 3.9 Interview each victim and witness. Also, if possible, interview those who were present before the accident and those who arrived at the site shortly after the accident. 3.10 Determine causation: What was not normal before the accident? Where the abnormality occurred? When it was first noted? How it occurred? Why the accident occurred? A likely sequence of events? Probable causes (direct, indirect, basic)? 3.11 Determine contributing factors such as the following: Unsafe acts Unsafe conditions Process deficiencies Violated policy/procedure Operating without authority Poor housekeeping Lack of training or skill Improper instruction Horseplay Improper PPE PPE failure
Poor ventilation Failure to lockout Improper guarding Improper maintenance Unsafe equipment 3.12 Establish corrective actions to prevent similar occurrences in the future. Consider policy or program changes, engineering solutions, and training in determining corrective actions. 3.13 Prepare an accident investigation form, including the recommended actions to prevent a recurrence. Return to the OPP Safety Office within 3 working days following the accident. If the accident was a lost time injury. 4.0 SERIOUS INJURY REPORTING PROCEDURES If any accident results in very serious injury [such as serious exposure to hazard chemicals (ex. ammonia, chlorine gas, etc.), major broken bones, major laceration and blood loss, paralysis, amputations, loss of sight], death or the hospitalization of 3 or more employees, the employee supervisor or manager must immediately call the OPP safety office via the following call list: Table 1. Report of Serious Injury Contact List Department Name Position Office Phone Cell Phone Landscape, Staff (with exception of Design and Construction Services) Don Fronk Safety Coordinator 814-865- 1661 814-937- 9873 Central/Area/Custodial Jennifer Kness Safety Specialist 814-863- 5528 814-470- 6409 Utility Services/ George Benko Safety Specialist 814-421- WCSP/ WWTP 8412 Renovations Services/Design and Construction Services Jonathan Risley Safety Specialist 814-867- 0183 Vacant OPP Safety and Training Office Supportjln16 814-863- 2340 PSU EHS 814-865- 6391 570-263- 6130
5.0 RESPONSIBILITIES 5.1 Employee Report all injuries, accidents and near misses immediately to supervisor Seek necessary medical attention through OccMed Services immediately Immediately following an injury, fill out and submit an Employee Injury Statement located on the OPP website under Safety and Workman s Compensation Information on the intranet main page. 5.2 Supervisor Responsibilities Fill out and submit First Report of Injury Form. Use employee injury statement as a guide. Make sure employee has sought proper and immediate medical attention If necessary, make certain scene of accident is properly secured and is not a hazard to other employees Conduct accident investigation. As many details and as much data is that can be collected at the time of the accident and at the accident scene itself should be taken to ensure a thorough investigation. Complete and submit the OPP Accident Investigation Form to the OPP HR/Safety Office. 5.3 HR/Safety Specialist Evaluate first report of injury and accident investigation forms for prevention of future accidents and injuries. Provide training on proper accident investigations to supervisors. Aid supervisors in initiating corrective actions based on investigation. Keep all records on file for a minimum of 30 years. 6.0 Lost Time Meetings 6.1 Following a Lost Time Accident, there will be a 30 minute briefing session within 15 days of the lost time accident to discuss the root cause of the accident, and to evaluate the methods of control and corrective action. This briefing will include the following panel: Deputy Assoc Vice President Director of the work group Manager of the work group Supervisor of the injured employee OPP Safety Coordinator and/or Safety Specialist
APPENDIX A
Employee Data Employee's Name: Department: Work Group/District: How long have you been employed at OPP: Location of accident (Building, Room Number): Job Title: Shift: Today's Date: Date of accident: Time of accident: AM PM ( choose ) Supervisor Name: Accident Data/Contributing Factors Detailed narrative of how incident occurred: INCIDENT INVESTIGATION FORM Directions for Completion: 1. Notify OPP H&S specialist within 24 hours of incident (Employee Injury, Near Hit, Property Damage). 2. Complete and submit this form to the OPP Safety Office within 3 working days of the accident/incident. 3. Please remember to sign and date the form. 4. Make five copies of this form for any Lost Time Injury Investigations. Employee Injury Near Hit Incident Property Damage Signature: Full Time Part Time Wage Description of Pictures Taken: What was employee doing just prior to accident (job task, include any tools or machinery used): Body part injured and type of injury (be specific): If it is a Near Hit, descibe the potential injury/damage: Weather conditions at time of accident: Visibility/Lighting (ex. poor, work lights, etc.): Type and condition of floor surface (ex. concrete, wet): PPE required for job: Was PPE being utilized? Yes No Was there any damage to property or equipment? Explain: Name(s) of witness(es): Name(s) of witness(es): Yes No Phone# Phone#
What action was or should be taken to prevent recurrence? Corrective actions completed? Yes No If no, explain: Investigated by: Date: Reviewed by: Date: TSS/2-10