Slide 2(B) Accident Investigation
Accident investigation
-A systematic management technique and method where work-related
injuries, ill-health or incidents are systematically studied and analyzed,
to identify root causes, immediate causes and contributing factors
(NIOSH, 2005)
Why investigate?
-To identify the root cause
-To prevent future accidents or recurrence
-To show management commitment to safety and health at the
workplace.
-To further improve on safety.
When to investigate?
As soon as possible after attending to injured person.
When situation is under control.
What to investigate?
FACTS not fault finding
who is injured?
What happened?
When did it happen?
Where did it happen?
Why did it happen?
How did it happen?
Who should investigate?
• The Manager or his representative.
• Member/s of the safety and health committee.
• The immediate supervisor of the injured person.
• The Safety and Health Officer/Expert in safety and health.
• Accident witness/witnesses
How to investigate?
• Isolate the accident scene
• Record ALL evidences
• Photograph, sketches, samples
• Identify witness
• Interview witness
• Interview representative of management
Isolate the accident scene
• The accident area and its surroundings
are to be isolated, fenced off by tapes to
keep curious onlookers from removing,
disturbing, unknowingly destroy initial,
vital evidence.
• This is done after the emergency
procedures have been executed and all
injured worker being removed.
• All evidences are collected, observed
and recorded.
• the longer an accident scene is not
isolated, the more likely the evidence
will be disturbed
• Record ALL evidences
It is important to make a permanent record of all
evidence soonest because:
(a) certain types of evidence may be perishable and
(b) there may be tampering
• Photograph or videotape the scene
• When recording evidence, it is better to
use photographs and/or videotape the
scene.
• It is better to have more shots than
necessary than to risk missing a vital
piece of evidence.
• Evidences can be recorded in variety of
ways also such as through written
notes, sketches diagrams including
measurements.
• Identify witness
In identifying witnesses, it is important to compile a witness list to
identify:
(a) Primary witness : the injured person
(b)Secondary witness : the eye witness
(c) Tertiary witness : somebody involved in similar
activities and can offer variety of corroborative
statements regarding the acts of people or
environmental
Interview of witness
• Interview of witness is preferable in the
above order. Once all the witness have been
interviewed, it may be necessary to re-
interview the witness for clarification.
• The techniques used for interviewing
accident witness are important so as to be
objective, accurate, untainted by personal
opinions, feelings of the witness.
• It is best to remind the witness the purpose
of the interview is purely to formulate the
right preventive measures to prevent similar
occurrence and not affixing blame, and we
are interested in facts rather than theory.
• When, where and how.
• Interviewing Witnesses
• Putting witnesses at ease
• Explain fully purpose of investigation
• Encourage participation and involvement
• Show interest in any ideas they might have
about possible preventive measures
• Witness must be assured that the purpose of
the investigation is not to blame anyone, but to
attempt to find out the cause and thereby
reduce possibility of a recurrence
• Interviewing Witnesses
• Interview Location
• Best to carry out interviews at scene of accident,
as it is easier for those involved to communicate
effectively with “props” close to hand
• Easier to explain what happened if witnesses are
able to point out specific things and recall their
actions related to specific locations
• Question Phrasing
• Typical questions:
• What happened? What did you see?
What time was it?
• Where were you at the time? Where
was the victim?
• When did you realise something was
wrong?
• How did it happen? How were you
involved?
• How could it have been prevented?
• Who else was involved? Who else
saw it? Who reported it?
• Conclusion
• When witness’s account of accident has been
heard, investigator should repeat it to witness
to ensure account is fully understood
• Interview should be concluded on a positive
note, which is best achieved by discussing any
ideas he may have regarding prevention of a
similar occurrence - this will serve to reaffirm
the purpose of the interview and ensure the
witness’s further co-operation, should it be
needed
• Interviewing the Injured Person
• Ideally first to be interviewed
• Injuries may be serious, or may be suffering from
shock
• Should be interviewed at the earliest opportunity
• General principles for interviewing witnesses apply
• The Investigation
• Promptness
• As soon as possible after the event
• Facts will be easier to determine and
more details will be remembered by those
involved
• Interviewing Immediate Supervisor (Management
Rep) –The last interviewee
• Supervisor will give details on questions put to him as
follows:
(a) Was there a safe work procedure?
(b) Was there a safe system of work?
(c) Did worker follow instructions given?
(d) Have training been given?
(e) Was worker Informed of hazards present?
(f) Was any supervision provided?
(g) Were the environmental conditions safe?
(h) Was machine provided with appropriate guard?
(i) Was the equipment/plant/tool used properly maintained?
Submit Report :
• Report the findings in the light of the above
investigation and communicate the preventive and
corrective measures to respective workers and staff
for their information so as to prevent recurrence of
similar accident. Evaluate the effectiveness of the
action taken for continuous improvement.
• Accident Reporting
Accident Investigation Records -Format:
• Name & personal details of victim
• Date, day and time of accident
• Location of accident
• Occupation of victim
• Job being done at time
• Nature of injury or damage
• What inflicted the injury or damage
• Who had control of the cause of the injury or damage
• What actually happened
• Basic and immediate causes
• Immediate remedial action taken
• Recommendations to prevent recurrence
• An investigation which does not discover what went
wrong, and produce some useful information and
recommendations for corrective action, is just a
waste of time
• Accident Investigation Procedure
1. Inspection of the accident scene to collect any
information relating to physical conditions of the plant,
equipment and building
2. Interview witnesses and others likely to give information
concerning any unsafe acts or conditions which may
have contributed to the accident
3. Summarise all available evidence accurately in a written
report to management, recommending future actions to
prevent a recurrence
• Inspection of the Scene
• Careful, detailed look at accident scene, evaluating and
noting the following:
• Extent & severity of damage
• Damage to surrounding property
• Environmental conditions which may have had some
bearing on the accident, such as temperature,
ventilation, humidity and illumination
• Survey the accident scene to see if there are any obvious
dangerous physical conditions which may have been
responsible for the accident
• Talking with On-Site Personnel
• Easy to upset people when asking questions about what
has been done, or what has not been done
• Casual remarks made during the site inspection may be
quite revealing and the investigator should continue to
talk to any personnel involved near the scene of the
accident
• This would also serve as an ideal opportunity to explain
the object of the exercise is to discover and root out the
causes so as to prevent a repetition. It is not to apportion
blame or to criticise any individual
• What Should be Investigated
• ALL incidents/accidents should be investigated
• Purpose is to find the cause, with the intention of
preventing a recurrence, rather than apportioning blame
• An injury usually involves some degree of blame falling on
management, supervision, victim or workers
• Why accidents are not reported?
• Repercussion or fear of discipline
• Concern about safety records
• Concern about reputation and image
• Fear of medical treatment
• To avoid work interruption or productivity losses
• Avoid red tapes
• Ignorance of their rights or safety mgt
