Accident and Incident InvestigationInvestigate accidents and incidents to prevent re occurrence can help protect your workers.
When an accident and incident occurs, having a plan that outlines what to do will help responders provide care for those involved. An incident investigation plan also provides a framework to gather the information needed to help prevent a similar incident in the future.
After all 95 percent of accidents are caused by human error which is a complex phenomenon comprising slips and lapses, mistakes and violations.
Many theories can be used to explain why an incident happens, but when someone is injured, none of those necessarily matter. What is important is that something went wrong and there is an immediate need to deal with the circumstance in a compassionate and organized manner.
Incident investigation plans, like other safety plans, should be tailored to meet the needs of the facility. They may include checklists or other pre-printed forms to help anyone responding gather the information that will be needed.
The 7 steps below will help you to thoroughly investigate incidents.
1. Deal With Immediate Needs
The first priority is taking care of victims’ needs. A trained workplace first-aider responder should always be available to attend to any incident serious or not.
Isolate the immediate incident scene to provide privacy to the individual and to prevent other hazards from harming the victim or others in the area. If it’s appropriate, take pictures to preserve evidence of the scene, but be aware that in some situations this may be insensitive.
Secure and isolate the area around the incident. Use physical barriers if immediately available or by running out tape (e.g. hazard or danger tape) to prevent people from walking into and contaminating the area. Protecting the areas by prohibiting access helps to preserve any evidence and will help the investigator assess all available evidence to establish what happened. Your staff or at least supervisors should be taught these basic scene protection and evidence preservation principles which could ultimately provide an account of what happened.
Inform management, supervisors, or anyone else that needs to know about the incident. An investigation team may be justified provided members are familiar with the fundamentals and it is vital a leader is appointed and takes charge. Some staff from the affected department, familiar with operations should be part of the investigation team. Worksafe will need to be advised in serious cases, known as Notifiable Events. (The Worksafe website provides a full list of notifiable injuries, illnesses and incidents). In simple terms, if the injured person is injured in the workplace and it is likely to be admitted to a hospital for treatment for more than 48 hours then a notification is required. This can be done by phone or online as soon as possible.
Investigation preparedness starts long before an incident happens. As teams are trained to investigate incidents, one thing that helps them to be prepared is incident investigation kits that contain the tools and items that may be needed during an investigation. Kits can be customized depending upon the unique needs of the facility or the abilities of the responder, but often include items such as:
Camera or modern phone with high res camera and zoom
Lighting or torch, batteries, clipboard, paper, measuring tape, caution tape, gloves, goggles, PPE, chalk or fluoro paint. pens, pencils, padlocks, sample containers
You should use a standard reporting and investigation form (either printed or electronic). Start with the time, date and place of the incident, the name of the victim or victims, any witnesses and the names of anyone on the investigation team. There should be space to document the incident and provide a framework for the team to review the facts and revise plans to prevent a similar incident in the future.
Take pictures and support with video (modern phones can be very handy to quickly and efficiently capture sweeps of the entire scene). Sketches may support specifics of what has happened. Conduct interviews while the incident is still fresh in everyone’s mind, and if people cannot remain at the scene a preliminary discussion to gauge their involvement and evidential contribution. It is best to interview witnesses individually to help ensure the integrity of the information.
After the initial investigation, review the information that has been gathered to help further determine the root cause of the incident. Some supporting documentation such as operation manuals, safety procedures, training records, and previous audits will also be helpful. identify corrective actions. These are plans to prevent this incident and similar incidents from reoccurring. For example, develop or update written plans, change processes, update procedures or review personal protective equipment use.
After the incident investigation has determined which recommendations to implement, update plans and procedures to reflect those changes. Workers will then need to be trained on any changes that affect how they perform their jobs so as to prevent a recurrence.