Fillable Omd, Agp Accident Illness Report Form (Page 3 of 5) in pdf

Completing the Accident/Incident Analysis

All close calls, near-misses, incidents, and accidents should be analyzed for corrective action regardless of

severity. Time and distance work against a thorough analysis as most people quickly forget important

facts and key details.

Distance from the incident means loss of visual information, so complete the analysis at the scene as soon as

possible. This form should be completed by the immediate supervisor of the person(s) directly involved in the

incident. A manager, safety committee, safety officer or analysis team can assist in the absence of the

immediate supervisor. This form asks no questions other than a brief description of an injury, if one occurred.

Questions often provide closed answers, so the key items on the analysis document are designed to encourage

open dialogue and communication about facts and details. This is the primary opportunity for those involved to

gather key information for preventing similar incidents in the future.

A Successful Analysis Process: The person(s) conducting the analysis need to look at the systems/

procedures/policies within the business that are not working and may have contributed in some way to the

incident. Even minor contributions should be listed. The systems to review are: Management, Employee,

Equipment, and Environment (MEEE). Review system items shown in the left margin of the

Accident/Incident Analysis form in relation to the incident. These are areas to explore within these

systems, they are not questions. Once the contributing system elements are identified, write them in the

Counter measures/best practices box along with any other system changes that will prevent recurrence.

First Step - Care for the injured: Insure appropriate medical care or first aid is provided for anyone injured.

Second Step - Secure the scene of the accident: Make certain that key evidence is preserved so that all

pertinent facts of the accident can be determined. In the case of serious accidents, photographs of the

scene are a valuable tool in determining causes, particularly if the area needs to be put back in order

quickly. Note the position of equipment and materials, presence or lack of equipment safeguarding, specific

materials and chemicals involved, warning signs and any other physical evidence.

Third Step - Interview witnesses: Witnesses to the accident or persons having knowledge valuable to

the analysis should be met with individually. Emphasis should be placed on determining the facts, not on

placing blame. If the injured employee(s) is/are not seriously injured, they should be interviewed while

awaiting transport for medical treatment. All questions should be open-ended (who, what, when, where,

how and why), to encourage a detailed account of the facts. Yes and No questions should be avoided.

Fourth Step - Analyze data to determine causes and best practices to prevent recurrence: Refer to

your notes from the scene of the accident and witness interviews. Work backwards from the accident to

trace all causes to their source. It is helpful to have multiple people involved in determining possible

solutions. Each cause identified presents an opportunity for intervention to reduce the potential for future

accidents:

Leads to…

PIPE LOCATED

TOO LOW

Leads to…

STRUCK BY

(Environment)

FORKLIFT

LEAKING WATER

(Employee)

PIPE

RUNNING AND

(Equipment)

STEPPED IN WATER

(Management)

WORKER SLIPPED AND

FELL INJURING BACK

The Causes

The Accident

Fifth Step - Follow up on corrective actions: This is usually the function of the safety officer or safety

committee. At the next safety committee meeting, any accident analysis reports should be reviewed to

ensure appropriate corrective actions (Countermeasures/Best Practices) were identified. Furthermore, steps

should be taken to ensure that these actions have been implemented at the site of the accident as well as

in any other areas appropriate in the organization. Any accidents or incidents occurring, for which a report

was not completed, should be referred to the appropriate person responsible for completion of the report.

Oregon Military Department - AGP

October 2011

Omd, Agp Accident Illness Report Form Page 3

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