Forms
available in this Section
ULM Safety Manual - Table of
Contents
ACCIDENT INVESTIGATIONS
INVESTIGATING AND REPORTING A WORK-RELATED ACCIDENT
Accidents do not just happen, they are caused either by an unsafe
act
and/or an unsafe condition or a combination of the two. In some cases
the
person performing the unsafe act does not realize just how serious the
consequences can be. In most cases, an unsafe condition or improper use
of a tool is the cause of an accident.
Investigations of accidents and incident are necessary, not to set
blame
but to primarily determine the cause or causes and to do everything
within
reason to preclude the same thing from happening again. Incidents which
could develop into an accident are part of the investigation scheme to
prevent such occurrence.
An accident investigation must be conducted for any
incident/accident.
The report must include information on the person injured, a complete
description
of the incident/accident, a statement of what caused or might have
caused
the incident/accident and any corrective action that has been taken or
that should have been taken to prevent recurrence.
Before actually beginning an investigation of a work-related
accident
or incident, the supervisor/ investigator should be thoroughly familiar
with "EMPLOYEE REPORT OF INJURY/ ILLNESS" form and
the "INCIDENT/ACCIDENT
INVESTIGATION FORM DA 2000" (both forms are available at the Human
Resources Office). If the accident or incident involves a student,
visitor, or client, then the VISITOR/CLIENT
ACCIDENT REPORTING FORM DA3000 needs to be completed. After
affirming
that all necessary and appropriate
steps
have been taken to provide medical assistance to the injured, the
supervisor
will complete the following steps in investigating the accident:
- Survey the accident scene for information. Gather or note any
objects
that
might have contributed to the accident. Take whatever interim action is
needed to prevent recurrence of the incident until permanent action can
be formulated and implemented. It is the responsibility of the
supervisor
to recommend and initiate corrective action. Consult the Environmental
Health and Safety Office if necessary. Include a description of the of
the individual injured, a description of the incident/accident (bodily
injury vs. property damage), a statement of what caused or might have
caused the incident accident.
- Check the property/ building area for damage and note
specific locations such as "the third floor southwest corridor of the
Administration building outside room 3-91 on the left side of the
corridor". Be as specific as possible. Take pictures where
ever possible and attached to the report form. Check equipment being
used (computer, lawn mower, copier, power tool, etc.) to determine if
the equipment if functioning properly. If there is any question
about the equipment, take it out of service until it can be assured the
equipment is safe. Please include any state tag identification
numbers, serial number, model, and manufacturer from the equipment in
the inspection report.
- Get names, addresses and phone numbers of all witnesses.
Witnesses,
including
the person or persons involved, if they are physically capable, should
be asked to give a written statement. If not, take an oral statement
from
them. Statements should provide a description of what happened; what
activity
was taking place; what tools, if any were in use and any other
contributing
factors. Witness(es) should be informed that the investigation is
intended
primarily to determine the cause or causes to determine corrective
action
and not to place blame.
- Complete "EMPLOYEE REPORT OF INJURY/ILLNESS"
form and the "INCIDENT/ACCIDENT
INVESTIGATION FORM DA2000" if the incident/ accident involves an
employee and the VISITOR/CLIENT
ACCIDENT REPORTING FORM DA3000 if the incident involves a student,
visitor, or client. Promptly forward it to the Safety
Office
and the Human Resources Office. The Environmental Health and Safety
Officer will review the form for accuracy and completeness.
- Repeat accident patterns, whether by persons or circumstance
should be
noted,
investigations, and corrective actions identified.
Examples:
Same Individual: Employee slipped and fell at the same
location
a week ago
Same Operation: Another worker was involved in an
accident performing
the same operation several days ago.
As result of the investigation, the supervisor/investigator should be
able
to state: an opinion as to how the accident occurred; if an unsafe act
and/or condition was a factor in the accident; what interim actions
have
been taken to avoid recurrence; if any permanent action is necessary
and
a recommendation for any future action such as training, changes to
procedures
and/or environmental factors.
An accident is an occurrence that results in an injury or
property
damage. For employees, all personal injuries should have a DA2000
"Incident/Accident
Investigation Form" and "LDOL Employer's Report of Injury" completed.
An incident is an occurrence that could have
resulted
in an injury or property damage; or could have had an effect on
implementation
on the safety programs, policies and procedures. A narrative of the
incident
should be sent to the Safety Office.
Forms available for download in this Section:
| Form Name |
File types available |
| Employer Report
of Injury/Illness LDOD-WC-1007 |
PDF File |
| Incident/Accident Investigation Form - DA2000 |
PDF File |
| Student/Visitor/Client Accident Reporting Form - DA3000 |
PDF File |
| Incident/Accident Investigation Form - DA2000 |
Doc |
| Student/Visitor/Client Accident Reporting Form - DA3000 |
Doc |
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