Investigating Workplace Incidents (OSHA) (for Manufacturing)

FREE

LESSON 1 PRE-INCIDENT PLANNING

WELCOME! As a responsible member of the company's safety committee, you are expected to respond quickly to a serious incident at work by following a pre-determined investigative method. This course walks you through OSHA's four-step systems approach to workplace incident investigations.

LESSON OBJECTIVES After completing this lesson, you should be able to: distinguish between a workplace incident and an accident; identify the important elements in an incident investigation program; and understand the four principles of incident investigation.

Are you ready? Tap the button below to get started.

INCIDENT INVESTIGATION PROGRAM Working in production plants can be risky to one's health and safety due to hazardous equipment and dangerous working conditions. Before fatalities, injuries, or illnesses occur, it is essential to be prepared. Hence, an incident investigation program should be established and have a clearly stated and easy-to-follow written plan that includes guidelines for the following: Who should participate in an investigation? When should an investigation be conducted? Why should incidents be investigated? What are the necessary tools to have on hand? What are the procedures for conducting the investigation? In the first half of this lesson, we will identify these elements of an incident investigation program.

Who should participate? Aside from the supervisor, incident investigations should also involve properly-trained managers, union representative, safety committee members to be most effective. In some circumstances, such as when a serious injury or death occurs, other authorities may have jurisdiction. Working collaboratively will provide different perspectives to the investigation from members with different levels of expertise and experience.

When should it be conducted? Incident investigation should be conducted as soon as possible. Right after the incident has been reported Before the incident site have been disturbed or altered Before the victim(s) or witnesses forget what occurred

Why should we do it? An investigation of a worksite incident provides employers and workers with the opportunity to: discover hazards in their operations and flaws in their safety and health programs, promote positive workplace morale, save lives and money It also allows the management to identify and implement the necessary corrective actions to avoid future incidents.

What tools should you have on hand? A kit must be prepared ahead of time to be able to conduct an investigation promptly after an incident. An investigator's kit should include, but is not limited to, the following: Investigation and interview forms Barricade markers/tape and warning tags or padlocks Recording devices (for documentation) More of this will be discussed in the next lesson.

What are the steps to follow? The general steps in an incident investigation are as follows: Preserve/document the scene. Collect information. Identify the root causes. Implement corrective measures. This course will go through each of these steps in detail.

PRINCIPLES OF INCIDENT INVESTIGATION For an incident investigation to be effective, it should be based on a set of principles. The investigator should: know the language of incident investigations; understand that all types of workplace incidents should be investigated; conduct investigations that follow a systems approach; and recognize that the heart of every incident investigation is to discover the root causes of an incident and act on it. In the second half of this lesson, we will discuss these principles to guide you in conducting an incident investigation.

LESSON 2 THE SCENE: PRESERVE, DOCUMENT, AND COLLECT

WELCOME BACK! In the previous lesson, you learned about pre-incident planning. It is time to apply what you have learned. In this lesson, we will talk about the first and second steps of conducting incident investigations.

LESSON OBJECTIVES After completing this lesson, you should be able to: conduct scene management and scene assessment; determine the information to collect during incident investigation; and conduct witness management.

Are you ready? Tap the button below to get started.

Imagine yourself on a normal day at work. You already had your entire day planned, with the primary goal of inspecting assembly-line machines and verifying that they function properly. Then suddenly, one of the machine operators approached you. "Help! One of our operators in Area 7 slipped on a puddle of oil and fell!" What should you do?

RECALL: STEP 1 Which of the following should you document when doing scene management and assessment?

LESSON 3 ROOT CAUSE ANALYSIS

WELCOME BACK! In the previous lesson, you learned about the first and second steps of an incident investigation. In this lesson, we will talk about the third step -- identifying root causes.

LESSON OBJECTIVES After completing this lesson, you should be able to: identify different factors that cause an incident; identify tools for root causes analysis; and conduct root cause analysis.

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CONDUCTING A ROOT CAUSE ANALYSIS A successful root cause analysis finds all root causes, which are often more than one. In our example, a traditional investigation may find the cause to be "oil spilled on the floor" with the remedy limited to cleaning up and advising workers to be more careful. When conducting a root cause analysis to discover if there are systemic reasons for an incident, you should ask a lot of "what", "why" and "how" questions. Why was there oil on the floor to begin with? Were there any changes to the circumstances, procedures, or environment? Where did the oil come from? What tasks were being carried out at the time the oil was spilled? Why did the oil remain on the floor?  Why was it not cleaned? Had it been there for a long time? Was the spill notified to the authorities? Asking these questions may have revealed that the failure to implement an effective mechanical integrity program— including inspection and repair —that would prevent or identify oil leaks was the main cause of the spill. In contrast,   an investigation that focused solely on the immediate cause (failure to clean up the spill) would not have prevented future incidents because there was no system in place to prevent, detect, and correct leaks.

LESSON 4 IMPLEMENTING CORRECTIVE ACTIONS

WELCOME BACK! In the previous lesson, you learned about the third step of incident investigation. In this lesson, we will talk about the fourth and final step -- implementing corrective actions.

LESSON OBJECTIVES After completing this lesson, you should be able to: identify recommendations that will address a root cause of an incident; and determine some global corrective actions to implement.

Are you ready to learn? Tap the button below to get started.

IMPLEMENTING CORRECTIVE ACTIONS The investigation is not complete until corrective actions that address the incident's root causes are implemented. Implementation should include program-level improvements and should be supported by higher ups. In our example of the oil leak incident, superficial conclusions such as "Workers should have common sense" and weak corrective actions such as "Workers should be reminded to wear PPE" are unlikely to improve safety culture or prevent similar occurrences. Specific corrective actions should address root causes directly.