ACCIDENT INVESTIGATION

ACCIDENT INVESTIGATION 

OSHA 1994 - Regulation -SHC 

Section 13(1) 

A safety and health committee shall inspect the 

place of work, as soon as it is safe to do so, after 

any accident, dangerous occurrence, occupational 

poisoning i or occupational ldisease has occurred at 

the place of work


POLICY 

Objective of incident investigation should not 

be to apportion blame or fault finding but to 

determine the cause(s) in order to prevent 

recurrence of accident 

All i id t t b t d d d 

All incidents must be report, recorded and 

investigated by competent


POLICY 

All staff must give their full cooperation and 

assistance when requested, to the investigation 

team 

All recommendations arising from incident 

investigation must tbe discussed, d agreed and 

executed by the relevant action parties


Definition 

Incident 

• an unplanned event or chain of event, which has or could 

have caused injury or illness to people and/or damage (loss) to 

assets, the enviroment e.g near miss, accident, fire 

Accident 

• an event which resulted injuries or illness to people and/or 

damage (loss) to assets and the enviroments 

Near miss 

• an event which did not result in injuries or illness to people 

j p p 

and/or damage (loss) to assets and the enviroment


ACCIDENT - THE CONSEQUENCES 

Immediate 

• Death 

• Injury 

• Pain 

• Disease 

• Damage 

• Loss 

• Fear 

Short Term 

• Medical 

Treatment 

• Repairs 

• Replacement 

• Lost 

Production 

• Increased 

Cost 

• Disciplinei • Low Morale 

Long Term 

•Suffering 

•Disability 

•Lost Income 

•Insurance 

•Compensation 

•Mistrust 

•Profitability


Safety Iceberg 

1 Fatality 

100 

1,000 

10,000000 

100,000 

Lost Time Injuries 

Minor Injuries/Property 

damage 

Near Misses 

Unsafe Acts / Conditions


Purpose 

INCIDENT INVESTIGATION 

• Law (OSHA 1994) and Company requirements 

• Prevent recurrence 

• Essential element in Safety & Health Management 

• Contribute to good morale and overall safety 

awareness 

• Geared towards continuous OSH improvement thus 

increased productivity and improved work enviroment


AIM 

To find the root cause and to prevent recurrence 

Not to apportion or assign blame, satisfy 

Not to apportion or assign blame, satisfy 

insurance claims or defend against liabilities


TYPES OF INCIDENTS 

Injurious accident 

Non-injurious incident with asset damage 

Occupational illness or disease 

Near miss


Minor accident 

INVESTIGATION PARTIES 

• Relevant individual staff and/or line supervisor 

Major accident 

• Team comparising mixed discpline and expertise 

including safety personel and led by line manager


INVESTIGATION PARTIES 

Be objective and be impartial 

Gather the facts and information 

Isolate the contributor factors 

Determine corrective actions and action parties 

Implement corrective actions with target dates


METHODOLOGY 

Gather safety rules/procedures of the site and 

information on plant, machinery or facilities 

Isolate the scene of accident and do not disturb 

evidence 

Take photos, sketch, diagrams of the accident 

site/facilities 

Interview witnesses, affected or involed parties and 

obtain facts but not opinions or assumptions 

Isolate key contributory factors


OUTCOMES OF THE INCIDENT 

Negative results like death, injuries, production 

loss, property damage 

Positive results like rehabilitation, change in 

safety procedures, improvement in processes


CONTRIBUTORY FACTORS 

Environment e.g. noise, heat, light, fumes, bad weather 

Design e.g. worksite layout, tools/equipment 

Systems and procedures e.g. not present or inapproprite 

Human behaviour e.g unsafes acts, purchase wrong type 

of equipment


CAUSES OF INCIDENTS 

Immediate e.g. Unsafe act, using unsafe tools/equipment, 

incorrect procedures, poor housekeeping, unsafe 

condition 

Uderlying e.g. Poor training, poor maintenance, low 

safety morale, lack of enforcement of safety rules


INVESTIGATION INTERVIEW 

TECHNIQUES 

Inprivate 

Put them at ease 

State objective for accident prevention 

Blame - free environment 

Establish facts only 

No leading question 

Give appreciation


1. Event leading to the 

accident 

• System of work 

• Work instruction 

• Variations from safe 

practice/instruction 

• Workplace condition 

• Environment condition 

• Exact location of incident 

• Material/Equipment/Tool 

used or handled 

2. Facts of the Incident 

itself 

• State of system 

• Parties involed 

• Material/Equipment/Tool 

/fixtures in direct 

involement 

3. Relevant facts of what 

happened immediately 

after the incident 

• Direct resultant injuries 

to people damage to 

assets or environment 

• Event leading to 

consequential injuries i or 

assets/environment 

damage 

• Parties involed including 

emergency respons or 

recovery 

• Effectiveness of 

emergency respons or 

recovery

CHECKLIST TO ESTABLISH 

FACTS OF INCIDENT 

WHO 

WHAT 

• was injured 

• is the injury 

• saw incident 

• is the damaged or loss 

• working with injured 

• is the injured doing 

• assigned job to injured 

• had the injured been instruced to do 

• else was involved 

• tools were being used 

• has information leading to the incident • machine/plant/equipment was in use 

• previous similar accident or near misses 

and whether action had been taken to 

prevent recurrence 

• did the injured and witnesses see 

• safety rules were violated 

• safe system of work, permit/procedures 

• were the contributory causes of the 

accident 

• communication system was in use



WHERE 

HOW 

• did accident occur 

• did the damage occur 

• was the supervisor at that time 

• were the witnesses at that time 

• did the injury occur 

• was the medical response 

• could the accident been avoided 

• could better design help 

• could the supervisor have prevented the 

accident



WHEN 

• did the accident occur 

• did the comunication fail 

• did the injured start the job 

• was hazards explained 

• did the supervisor last see the injured 

• as something observed to be wrong 

WHY 

• did the injury occur 

• did communication fail 

• was training not given 

• were the unsafe condition permitted 

• were the hazard not evaluated 

• was PPE not given or not worn 

• was there no safe system of work, 

permitted or procedures 

• were specific instructions not given 

• was there no safety inspection or audit 

• was the level of safety awareness and 

commitment low 

• was there no safety program 

• was the injured there 

• was supervisor not notified when things 

went wrong 

• was the supervisor not there at the time


ACCIDENT CAUSATION 

Over 90% of all accident are caused by the action or inaction’s of 

people which are unsafe acts or unsafe conditions 

 

Recognise patterns of accident 

• people - any particular group or individual 

• behaviour - poor safety attitude 

• time- particular time, day, start/end week, shift 

• place - particular place, type of place, indoor/outdoor 

• activity - during a particular task, type of task, boring gj job, high 

speed, during difficult or complex task 

• system or procedures - any particular operations, system or 

procedures 

• equipment - specific type, old or new


1. Unsafe Acts 

• failure to wear PPE 

• wearing unsafe clothing 

• horseplay 

• improper use of hands and other parts of the body 

• bypassing safety devices 

• unsafe position or posture 

• driving errors 

• unsafe operation acts


2. Unsafe Conditions 

• defective tools and equipment 

• df defective design 

• unsafe clothing or PPE 

• unsafe workplace 

• inadequate layout and storage 

• unsafe guarding 

g 

• public hazards

BENEFIT OF ACCIDENT 

INVESTIGATION 

Prevent recurrence 

Identify out-moded operartion methods 

Improved work environment 

Increased productivity due to upgrading of process 

system 

Raising of safety awareness and morale 

Lower medical costs due to fewer accidents 

Avoid lawsuits or liabilities due to accidents 

Greater efficiency due to no work stoppages


ACCIDENT REPORTING FORM 

(refer to handout) 

DOSH - Accident Reporting Form 

Company - Accident Reporting Form 

Witness Interview Form


PRINCIPLES OF ACCIDENT 

PREVENTION 

The identification of hazards, risk assessment and risk 

control 

OSH promotion and communication to influence 

behaviour and encourage safe attitudes

ACCIDENT INVESTIGATION

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