PHASES OF THE INVESTIGATION
The objective of investigating an incident is to:
(1) Identify the contributing and root cause
(2) Recommend and implement corrective action
(3) Deter future occurrences of similar accidents
(4) Modify work activities through “Management of Change
(4) Determine the incident sequence without assigning fault or blame. An incident investigation is a structured process used to uncover the series of events that caused an accident.
There are three phases to the accident investigation utilized by the company. These phases include the following:
Discover facts on the sequence of events (Investigative Phase)
- Uncover the facts about the accident by gathering information and evidence, interviewing witnesses, and inspecting the scene.
- Identify how, what, who, when, and where the incident occurred, including all related factors (i.e., weights, heights, distances, time of day, weather conditions).
- Developing a sequence of events indicates a timeline regarding specific occurrences that led to the incident.
Analyze the information gathered (Analytical Phase)
- Determine the cause(s) (Why did the incident occur?). What acts, failures and conditions contributed to the event.
Corrective actions (Recommendation Phase)
- After the cause(s) of the incident has been determined, recommend corrective actions to prevent the recurrence of similar events.
Levels Of Incidents/Accidents
The following are the different levels of accidents and the investigations that shall take place in each event:
- Near Miss Incident: These incidents can range from potentially minor to profoundly serious and even catastrophic incidents. Near misses should be documented to determine the cause and recommend corrective actions.
- Minor Mishap: Investigate, interview the injured employee, determine causes, and recommend corrective actions in a documented form.
- Major Injury Recordable Incident: Investigate, interview the injured employee and witnesses, use methods, determine root causes and contributing factors, recommend corrective action, and provide a written report. Notify Alberta Workers Compensations Board
- Catastrophic event (loss of life, multiple injuries,): Investigate and Interview injured personnel; use analytical methods, determine all contributing factors, root causes, recommend corrective actions.
- Write a comprehensive report and explain the analytical methods used (root cause analysis).
When an accident occurs on a work site, having a structured process to investigate and identify the root cause is critical. An accident investigation process will allow you to find out what actually happened and make corrective action to a system or process to prevent future occurrences.
- Determine the root cause of the incident.
- Name the suspect-the person, machine, tool or part that is responsible for causing an accident.
- Enlist affected parties (i.e., supervisors and employees) and witnesses to assist in gathering information about the incident.
- Take pictures and document evidence at the scene of an accident using detailed notes and sketches.
- Use available computer software programs to help organize your investigation, they can link ideas directly to a timeline or Gantt chart!
- Conduct interviews with those involved as soon as possible after the accident occurs; record their statements verbatim if possible.
- Keep thorough documentation of how you arrived at your final conclusion regarding what happened during an accident..
- Accident Investigation must be conducted by a trained and experienced person that knows how to properly gather evidence, interview witnesses and analyze the issue.
Only after the above steps have been completed can corrective action be taken.