Accident incident investigations
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ACCIDENT/INCIDENT INVESTIGATIONS. WCB REGULATION: The Employer must immediately undertake an investigation into the cause of any accident or other incident that : resulted in injury to a worker requiring medical treatment

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ACCIDENT/INCIDENT INVESTIGATIONS

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Accident incident investigations

ACCIDENT/INCIDENT INVESTIGATIONS

WCB REGULATION:

The Employer must immediately undertake an investigation into the cause of any accident or other incident that :

  • resulted in injury to a worker requiring medical treatment

  • did not involve injury to a worker but had the potential to cause serious injury


Purpose of investigations

PURPOSE OF INVESTIGATIONS

PURPOSE:

  • to gather information on the cause(s) of an incident

  • to make recommendations to prevent future similar occurrences

  • to implement corrective measures ASAP


Viha accident incident investigation policy

VIHA ACCIDENT/INCIDENT - INVESTIGATION POLICY

When an accident or exposure results in medical aid, time loss from the workplace or has the potential to result in serious injury an investigation must be initiated within 72 hrs of the incident and completed without undue delay.


Employer responsibilities

EMPLOYER RESPONSIBILITIES

The Employer is responsible to ensure:

  • Investigations take place as soon as possible following an incident

  • Investigations are conducted by person(s) knowledgeable in the type of work involved


Employers responsibilities continued

Employers Responsibilities Continued

As far as possible the Investigation must:

  • determine the root cause or causes of the incident

  • identify any unsafe conditions, acts or procedures that contributed in any manner to the incident


Employers responsibilities continued1

Employers Responsibilities Continued

As far as possible the Investigation must:

  • if unsafe conditions, acts or procedures are identified, recommend corrective action(s) to prevent similar incidents


Employers responsibilities continued2

Employers Responsibilities Continued

Following an investigation the employer must without undue delay undertake any corrective action to prevent recurrence of similar incidents


Employers responsibilities continued3

Employers Responsibilities Continued

Following an investigation the employer must complete the Incident Investigation report/process by:

  • Indicating the status of the recommendations made (i.e. resolved, ongoing, deferred etc.)

  • Ensure dates, times and investigation information is accurate

  • Indicate any concerns you have about

    the incident


The investigators

THE INVESTIGATORS

The Investigators:

  • 1- 2 worker reps who are knowledgeable in the work involved

  • supervisor of area (if available)

  • a union rep if reasonably available

  • a joint OHS committee member if available


Conducting the investigation

CONDUCTING THE INVESTIGATION

Process:

  • Manager/Supervisor immediately reviews the accident/injury report form information upon receipt

  • Seeks clarification of incident details if required - speaks to witnesses if needed

  • Ensures any immediate hazards are removed


Conducting the investigation1

CONDUCTING THE INVESTIGATION

Process:

Immediately initiate the investigation by establishing the investigation team, providing the Investigation report form and any information you have that would be helpful to the investigation


Conducting the investigation2

CONDUCTING THE INVESTIGATION

Process:

Once the investigation team has completed the investigation process review the recommendations and findings to ensure they will be effective in preventing a similar repeat incident.


Conducting the investigation3

CONDUCTING THE INVESTIGATION

Process:

  • Implement recommendations made ASAP (or make/seek further recommendations)

  • Identify any concerns you have about the incident

  • Sign off where applicable and forward form as indicated


Investigation tips and guidelines

INVESTIGATION TIPS AND GUIDELINES

  • Gather the information:

    • Speak to the people involved

    • Determine exactly what happened

  • Analyse the information:

    • List, in chronological order, the sequence of events leading up the incident

  • Determine the cause(s) of the incident

    • Identify all contributing factors

  • Make recommendations

    • Focus on prevention of a repeat incident

  • Follow-up to ensure recommendations are implemented and effective


Investigation tips and guidelines1

INVESTIGATION TIPS AND GUIDELINES

  • EQUIPMENT:

    • Was there any defects in equipment, tools or materials that contributed to the incident?

    • Was the equipment known to be faulty prior to the incident? Why was it not reported,repaired/replaced?

    • Was the equipment appropriate for the job and readily available for the task?

    • Have workers been trained in the use of the equipment?

    • Are written safe work procedures in place to operate equipment/tools?


Investigation tips and guidelines2

INVESTIGATION TIPS AND GUIDELINES

  • ENVIRONMENT:

    • Was the location or position of the equipment, material or worker a contributing factor ? (ie. trip/slip hazards)

    • Was the hazardous condition/area identified previously and reported? If not, why?

    • Was there sufficient work space ?

    • Were environmental conditions a contributing factor? (Lighting, noise, ventilation, wet etc.)


Investigation tips and guidelines3

INVESTIGATION TIPS AND GUIDELINES

  • PEOPLE:

    • Was there a written work procedure for the task? Is it adequate and current ?

    • Was the worker trained on the procedure and did they follow it?

    • Was worker distracted or rushed ? Why?

    • Was the required Personal Protective Equipment available and was the worker wearing it?

    • Was the worker wearing appropriate footwear/clothes for the task?

    • If assistance was needed for the task did the worker request it and was it available ?


Investigation tips and guidelines4

INVESTIGATION TIPS AND GUIDELINES

  • SUPERVISION:

    • Was there a failure to detect, anticipate or report a hazardous condition?

    • Was there a failure to detect or correct deviations from the safe job procedures?

    • Were responsibilities adequately defined and understood by worker?

    • Was there failure to initiate corrective action for know hazardous conditions?

    • Was worker informed about potential job hazards?


Investigation tips and guidelines5

INVESTIGATION TIPS AND GUIDELINES

Potential Investigation Recommendations/Outcomes:

  • Equipment repairs, evaluations or purchases

  • Policy/Procedure/Process revisions/updates

  • Discussion/communication with worker(s) involved

  • Risk Assessment of area/concern

  • Provision of Personal Protective Equipment (goggles, gloves, face shield, respirator)

  • Work area enhancements or redesign

  • Training or re-training required

  • Update of Kardex, Care plan, ADL as needed

  • Evaluation of workload, work rotation or work activity


Example 1 msi over reaching

Example 1 - MSI - OVER-REACHING


Example 2 chemical burn

Example 2 - Chemical Burn

When investigating a Chemical Burntype injury some questions that can be asked are:

  • Was the right chemical being used for the right purpose?

  • Is the MSDS current and readily available?

  • Was Personal Protective Equipment worn as specified? (i.e. gloves)

  • Are there safe work procedures written for the safe use of the chemical?

  • Does the worker have adequate WHMIS training?


Example 3 slip trip fall

Example # 3Slip/Trip Fall

  • When Investigating a Slip/Trip type injury some questions that can be asked are:

    • What was the tripping hazard?

    • What immediate action needs to be taken?

    • What can be done to ensure the tripping hazard is dealt with over the long term?

    • Who needs to know any new information resulting from the investigation?


Investigations summary checklist

INVESTIGATIONS… Summary Checklist

  • Immediately review the incident report once received

  • Remove any immediate hazards or dangers that have the potential to cause injury

  • Initiate the Investigation process ASAP

  • Immediately follow-up on recommendations made and implement corrective measures

  • Ensure corrective measures are effective in preventing a similar repeat incident in future

  • Ensure the Accident and Injury report form is complete, signed off and forwarded as indicated

  • If you have questions or concerns about the Investigation process contact a Safety Advisor in your service area.


Remember

REMEMBER ….

  • Accidents are caused

  • Accidents can be prevented if causes are eliminated

  • The same accident will happen again if causes are not eliminated


Occupational health and safety services contacts

OCCUPATIONAL HEALTH AND SAFETY SERVICES - CONTACTS

  • Regional Manager of Occupational Health & Safety: Michael Colussi - Ph: 519-7061 or Cell: 889-5597

  • Team Leader Safety:

    Darren Buckler - Ph: 519-7043 or Page: 978-3674

  • Safety Advisors Central Island:

    Tracy Larsen - Ph: 951-9506 (Parksville)

    Brian Kossey - Ph: 755-7691 (3097) Nanaimo


Occupational health and safety services contacts1

OCCUPATIONAL HEALTH AND SAFETY SERVICES - CONTACTS

  • Safety Advisors South Island:

    Ken Kamsteeg - Ph: 519-7044

    Judi Murakami - Ph: 519-7056

    Linda Gould - Ph: 519-7084

  • Safety Advisor North Island:

    Clarence Friesen - Ph: 286-7054

    Note: All contacts listed can also be contacted through the VIHA e-mail system.


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