igc-1 element 4 ver 1.0 updt 7-6-15

111
IGC-1 ELEMENT – 4 HEALTH AND SAFETY MANAGEMENT SYSTEMS - CHECK

Upload: suraj

Post on 09-Dec-2015

42 views

Category:

Documents


19 download

DESCRIPTION

nebosh

TRANSCRIPT

Page 1: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

IGC-1 ELEMENT – 4

HEALTH AND SAFETY MANAGEMENT SYSTEMS -

CHECK

Page 2: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

LEARNING OUTCOME

4.1 – Outline principles, purpose and role of active and reactive monitoring.

4.2 – Explain the purpose of, and procedures for investigating incidents (accidents, cases of work-related ill-health and other occurrences)

4.3 – Describe the legal and organizational requirements for recording and reporting incidents.

Page 3: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

4.1 ACTIVE and REACTIVE

MONITORING

Page 4: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INTRODUCTION

Organizations need to monitor their H&S performance to assess how effective they are, in the same way that they would measure finance, production or sales objectives

Monitoring - is an essential component of good management (what gets measured tends to get done).

Monitoring provides the opportunity and information to enable:

The assessment of effectiveness and appropriateness of H&S objectives and arrangements, including control measures.

The making of recommendations for review of current management system.

Page 5: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

MONITORING SYSTEMS

A need for a range of both Active and Reactive Measures to determine whether objectives have been met. A balanced approach to monitoring seeks to learn from all available resources.

Two forms of monitoring required:

1.ACTIVE MONITORING,2.REACTIVE MONITORING

Page 6: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

MONITORING SYSTEMS

ACTIVE MONITORING

Before the event, involves identification through regular, planned observations of workplace conditions, systems and the actions of people to ensure that performance standards are being implemented and management controls are working,

Ex. Workplace and plant inspections

Page 7: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

MONITORING SYSTEMS

REACTIVE MONITORING

After the event, involves learning from mistakes, whether they result in injuries, ill-ness and property damage or near-misses,

Ex. Accident Investigation

Page 8: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

ACTIVE MONITORING PROCEDURE

Page 9: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

OBJECTIVE of ACTIVE MONITORING

The primary objectives:

Check that H&S objectives and if plans have been implemented.

Monitor the extent of compliance with the organization’s systems/procedures and with it’s legislative/technical standards.

Active monitoring will tell the organization about the reliability and effectiveness of its systems, before their limitations are made obvious through accidents.

Active monitoring provides an opportunity for management to confirm commitment to H&S objectives.

Page 10: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

PROCEDURES of ACTIVE MONITORING OF PERFORMANCE STANDARDS

The various methods and levels of active monitoring:

Routine procedures to monitorPeriodic examination of documents, Systematic inspection of premises, Environmental monitoring and health surveillance,Systematic direct observation of work and behavior,The operation of audit systems,Consideration of regular reports on H&S

performance by the BoD.

Page 11: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

SYSTEMATIC INSPECTION OF PLANT AND PREMISES

The systematic inspection of plant and premises can identify H&S conditions. ex. Planned maintenance or cleaning operations.

Inspections on a Timely basis limit the harmful effects of sub-standard conditions.

Periodic Inspection gives early indication of standards of implementation by comparison.

Page 12: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Role of Inspections,

Sampling, Surveys and Tours in Monitoring

Page 13: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

SAFETY INSPECTION

Role of H&S inspections is to identify the H&S status of what is being inspected and what improvements are needed.

They are particularly well suited to identifying workplace hazards and bad practice determining if they are under satisfactory control or not.

Page 14: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

LIMITATIONS OF INSPECTIONS

Inspections may not identify an unsafe activity if:

The associated work was not taking place during the inspection,

Some hazards are not obvious,Not observed or identified by the

inspector,Lack of knowledge,Competence for the work area.

Page 15: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

A serious accident has occurred. During the investigation it is found that an inspection of the work site had taken place before the accident.

Outline possible reasons why the inspection

did not lead to an unsafe situation being corrected. (8)

Page 16: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The role is to select a representative, partial amount of a group of items, people or area, which is examined to established facts about it and used to indicate the standard of compliance of the whole group.

Sampling is conducted relating the following:

1. Specific Hazards – ex. Noise, dusts

2. Good Practice – ex. Wearing PPE

3. General Workplace Hazards – ex. Identified during safety walk

SAMPLING

Page 17: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

SURVEY The role of a survey is to examine a narrow field of H&S programme on an exploratory basis with no fixed expectation of findings. “Survey” is usually applied to an exercise that involves a limited number of critical aspects, ex.

Noise survey – w/the aid of noise measuring equipment

Lighting survey – w/ the aid of light meter

Temperature survey – w/ the aid of thermometer

(high and low)

Personal Protective Equipment – usually involving a review

of standards and workplace conditions/activities.

Page 18: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The term survey is also used to define an exercise in which managers and workers are interviewed in order to identify knowledge, understanding and details of specific needs within the working environment. Ex. 1. Training needs – usually involving written questionnaires

to managers and workers. 2. Attitudes to H&S – usually involving written

questionnaires to managers and workers.3. Need for specific H&S rules for specific tasks – usually

involving the review of standards and workplace conditions/activities.

SURVEY

Page 19: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

SAFETY TOURS

The role of tours is to provide an opportunity for the management to explore the effectiveness of risk control measures through planned visits to the workplace to observe and discuss the controls in use by the workers carrying out the tasks.

Tours can indicate deficiencies or success in managers carrying the organization’s objectives through to action.

Page 20: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

APPROACH TO INSPECTIONSFactors to consider during the inspections planning stage:

What needs inspecting? Who is to conduct the inspections and are they competent? When should inspections be conducted: changing circumstances or

regular frequency? What standards are to be used? Is a checklist required? What equipment is to be used and does it need to be calibrated? Is any personal protective equipment (PPE) required? Where are findings recorded? Who will prepare the inspection report and develop the action plan? Who will be responsible for ensuring that any remedial action is

carried out?

Page 21: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

FREQUENCY AND TYPE OF INSPECTIONS

There are different types of inspections for different purposes, they include :

General workplace inspection – carried out by first line managers/workers H&S representative

Statutory thorough examination of equipment – carried out by specialist competent person (ie. Third Party)

Statutory inspection of equipment – carried out by competent person

Preventive Maintenance inspections of specific (critical) items – carried out by maintenance staff.

Pre – use checks of equipment – carried out by the user.

Page 22: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

FREQUENCY AND TYPE OF INSPECTIONS

The frequency of inspections should be planned to take place at regular intervals. The time between most inspections is often at the employer’s discretion.

Frequency of the inspection is influenced by, are:

1. Changing nature of the workplace2. Manufacturer’s recommendations3. Type of use4. Frequency of use5. Environmental conditions6. Severity of failure7. Previous history of failure8. Minimum intervals set by legislation9. Periodic basis

Page 23: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

COMPETENCE OF INSPECTORS

The qualifications; Knowledge, Skills (ability), Training, Experience. (KATE)

The techniques; Recognizing conditions that are of good standard, Recognizing conditions that are or will become substandard, The acceptable response to what they find.

Limitations; One of the most important competencies an inspector must have is the ability to know their own limitations of competency and what action they should take when they identify something that falls within their limitations.

Page 24: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

USE OF CHECKLIST (advantages)

Enables prior preparation and planning

Quick and easy to arrange

Brings a consistent approach

Clearly identifies standards

Thorough (detailed)

Provides ready made basis for inspection report

Provides evidence for audits

Page 25: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

USE OF CHECKLIST (disadvantages)

Does not encourage the inspector to think beyond

the scope of the checklist.

Items not on checklist are not inspected.

May tempt people who are not

authorized/competent to carry out the inspection.

Can be out of date if standards change.

Inspectors might be tempted to fill in the checklist

without checking the work area/equipment.

Page 26: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

ALLOCATION OF RESPONSIBILY AND PRIORITY FOR ACTION

• Records should be kept for each inspection with details of both positive and negative findings. There should be arrangements to ensure that safety improvement actions will be taken by appropriate personnel.

• There should also be arrangements for reporting hazards. Staff and workers should be reminded to consult their supervisors if they feel unsure of their operations. Supervisors should monitor the performance of their staff and workers and take positive action including stopping work, where necessary, when hazardous situations are spotted.

Page 27: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Once any correction/control measures have been identified during inspection, management must decide what corrective action, if any, to take based on the recommendations. For high risk activities or high risk conditions this would include a decision about whether the work should actually take place.

Where extra measures are needed, establish clear timescales, responsibilities and resources for carrying out the controls. For large events or where a range of measures is required an action plan may be needed, giving further details on the programme for putting the controls into action.

ALLOCATION OF RESPONSIBILY AND PRIORITY FOR ACTION

Page 28: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

a.) Outline the role of workplace health and safety inspection. (4)

b.) Give TWO strengths of using a checklist when carrying out an inspection. (2) c.) Give TWO weakness of using a checklist when carrying out an inspection. (2)

EXAM QUESTION

Page 29: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Effective Report Writing

Page 30: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EFFECTIVE REPORT WRITING

The primary purpose of written information is to communicate. One useful means of communicating information is the report.It is important to produce a report which has the right style for the purpose it is being used;

Use of plain English,Style of report writing tends to be written

formally, factually,In the past tense, and From the perspective of the 3rd person

Page 31: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

STRUCTURE OF THE REPORT

INTRODUCTION and BACKGROUND

SUMMARY

MAIN BODY OF THE REPORT

RECOMMENDATIONS

CONCLUSIONS

Page 32: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

04/18/2023 07:49 AM

CONTENTReport content should be logical, systematically written.

Introduction of the report should be given to understand what is the report about.

A general details of the findings and status of the inspected area should be mentioned in the summary.

Then a detailed finding should be mentioned. It should give a clear idea of the main findings.

Report should clearly give recommendations for the improvement with expected time frame.

Report should conclude with final words stating why it is important to take actions . It should be persuasive.

List of all finding should be attached with the report.

Page 33: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

04/18/2023 07:49 AM

PERSUASIVENESS

Persuasive writing, is a form of writing in which the writer uses words to convince the reader that the writer's opinion is correct in regards to an issue. Persuasive writing sometimes involves persuading the reader to perform an action, or it may simply consist of an argument or several arguments to align the reader with the writer’s point of view.

Page 34: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Reactive Monitoring Procedures

Page 35: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

OBJECTIVES OF REACTIVE MONITORING

OBJECTIVES: to measure negative outcomes, to ensure H&S in order to identify the

significance of this outcome, and opportunities for improvement.

Page 36: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

These method are deemed to be after the event and are therefore reactive monitoring measures;

Identification Reporting Investigation Collation of data and statistics, on the

events

METHODS OF REACTIVE MONITORING

Page 37: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INCIDENT STATISTICSACCIDENT / ILL HEALTH INCIDENCE RATES

Number of accidents/ill-health in the period * 100,000 _______________________________________

Average number of people that worked during the period

Page 38: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INCIDENT STATISTICSACCIDENT / ILL HEALTH FREQUENCY RATES

Number of accidents/ill-health in the period * 1,000,000 _______________________________________

Total hours worked during the period

Page 39: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INCIDENT STATISTICSACCIDENT / ILL HEALTH SEVERITY RATES

Total number of days lost * 1,000 ____________________________

Total hours worked

Page 40: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REACTIVE MONITORING MEASURESReactive monitoring should be done through the data on all types of accidents:

IncidentNear missAccidentIll – healthDangerous occurrenceComplaints from workersEnforcement authority actions.

Page 41: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

4.2 INVESTIGATING

INCIDENTS

Page 42: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

04/18/2023 07:49 AM

ROLE AND FUNCTION OF INCIDENT INVESTIGATION

AS A REACTIVE MONITORING MEASURE

Page 43: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• Important part of any safety management system. Highlights the reasons why accidents occur and how to prevent them.

• The primary purpose of accident investigations is to improve health and safety performance by:Exploring the reasons for the event and identifying both

the immediate and underlying causes;Identifying remedies to improve the health and safety

management system by improving risk control, preventing a recurrence and reducing financial losses.

ACCIDENT INVESTIGATION

Page 44: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• All accidents whether major or minor are caused.

• Serious accidents have the same root causes as minor accidents as do incidents with a potential for serious loss. It is these root causes that bring about the accident, the severity is often a matter of chance.

• Accident studies have shown that there is a consistently greater number of less serious accidents than serious accidents and in the same way a greater number of incidents then accidents.

WHAT TO INVESTIGATION

Page 45: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Many accident ratio studies have been undertaken and the one shown below is based on studies carried out by the Health & Safety Executive.

189Non Injury Accidents/Illnesses

7Minor injuries or illnesses

1Major injuryOr illness

BIRDS TRIANGLE

Page 46: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• In all cases the ‘non injury’ incidents had the potential to become events with more serious consequences.

• Such ratios clearly demonstrate that safety effort should be aimed at all accidents including unsafe practices at the bottom of the pyramid, with a resulting improvement in upper tiers.

• Peterson (1978) in defining the principles of safety management says that “an unsafe act, an unsafe condition, an accident are symptoms of something wrong within the management’s system.”

Accident Studies

Page 47: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• All events represent a degree of failure in control and are potential learning experiences. It therefore follows that all accidents should be investigated to some extent.

• This extent should be determined by the loss potential, rather then just the immediate effect.

Accident Studies

Page 48: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Incident: An incident is defined as the outcome of an unplanned, uncontrolled event.

This may include such things as injury, ill – health, dangerous occurrence, near miss or property damage.

Incident also considered as nearmiss

DISTINCTION BETWEEN DIFFERENT TYPES OF ACCIDENTS

Page 49: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Injury “Physical harm or damage done to or suffered by a person.”

Ill – health “Harm to person’s health caused by their work.”

Dangerous occurrence“An incident dangerous in nature but not resulting in personal injury reportable to the competent authority.”

DIFFERENCE BETWEEN DIFFERENT TYPES OF INCIDENTS

Page 50: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

DIFFERENCE BETWEEN DIFFERENT TYPES OF INCIDENTS

Near miss“An accident that results in no apparent loss but narrowly escaped from a big harm.”

Damage only“Incidents relate to hose events could have caused harm to people but only cause damage to property, equipment, the environment or production loss.”

Page 51: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

04/18/2023 07:49 AM

Ill-health: An abnormal health condition or disorder(physical or mental) that is caused or aggravated by exposure to environmental factors associated with employment, including chemical, physical, biological and ergonomic factors.

Records should be maintained for all complaints from workers and enforcement authority actions.

DIFFERENCE BETWEEN DIFFERENT TYPES OF INCIDENTS

Page 52: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

STAGES IN AN ACCIDENT/INCIDENT INVESTIGATION

The stages in an accident/incident investigation are shown in the following diagram.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

Page 53: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• When accidents and incidents occur immediate action may be necessary to:

Make the situation safe and prevent further injury.

Help, treat and if necessary rescue injured persons.

• An effective response can only be made if it has been planned for in advance.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

DEALING WITH IMMEDIATE RISKS

Page 54: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The greatest effort should be put into:Those involving severe injuries, ill-health

or loss.Those which could have caused much

greater harm or damage.These types of accidents and incidents demand more careful investigation and management time. This can usually be achieved by:

Looking more closely at the underlying causes of significant events.

Assigning the responsibility for the investigation of more significant events to more senior managers.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

SELECTING THE LEVEL OF INVESTIGATION

Page 55: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The purpose of investigations is to establish:

• The way things were and how they came to be.• What happened – the sequence of events that

led to the outcome.• Why things happened as they did analysing

both the immediate and underlying causes.• What needs to be done to avoid a repetition

and how this can be achieved.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

INVESTIGATING THE EVENT

Page 56: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

A few sources should give the investigator all that is needed to know.

ObservationInformation from physicalsources including: Premises and place of

work Access & egress Plant & substances in use Location & relationship of

physical particles Any post event checks,

sampling orreconstruction

DocumentsInformation from: Written instructions;

Procedures, riskassessments, policies

Records of earlierinspections, tests,examinations andsurveys.

InterviewsInformation from: Those involved and

their linemanagement;

Witnesses; Those observed or

involved prior to theevent e.g. inspection& maintenance staff.

Checking reliability, accuracy Identifying conflicts and resolving differences Identifying gaps in evidence

SOURCES OF INFORMATION AND EVIDENCE

Page 57: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

When preparing for an accident investigation the following factors should be considered;

Determine who should be involved in order that the investigation or team has all the necessary skills and expertise.

Ensure that the accident scene remains undisturbed in so far as it is reasonable and safe to do so.

Collate all relevant existing documents such as previous incident reports, maintenance records, risk assessments, etc.

Identify the persons (witnesses) who will need to be interviewed during investigation.

Check that relatives of any injured person have been notified. Check that legal reporting requirements have been met. Ascertain the equipment that will be needed, ex. Measuring tape,

camera. Determine the style and depth of the investigation.

FACTORS TO CONSIDER

Page 58: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

To ensure that the investigation team has all the necessary information, training in some of the following areas may be required;

The importance of reporting accidents and incidents for legal, investigative and monitoring reasons.

The types of incident that the organization requires to be reported.

The lines of reporting. How to complete internal documents and forms. Responsibilities for completing the accident book.

ACCIDENT INVESTIGATION

Page 59: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The scene of the accident may still be highly hazardous. Anyone wishing to assist the injured party must take care, so that they too do not become a victim.

The investigation must begin as soon as possible after the accident.

Keep the objective clearly in mind to discover the causes in order to initiate remedial action, not only to find someone to blame.

Witnesses must be interviewed one at a time and not in the presence of any other witnesses to avoid influencing subsequent statements.

Identify the root causes of the accident, not only immediate ones. Avoid making early unqualified assumptions. Approach witnesses without bias or pre-conceptions. Notes should be taken, so that the investigator is not relying on

memory.

INVESTIGATION GUIDELINES

Page 60: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INTERVIEWS, PLANS,PHOTOGRAPHS,

RELEVANT RECORDS AND CHECKLIST

Page 61: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• Interviewing the person(s) involved and witnesses to the accident is of prime importance, ideally in familiar surroundings so as not to make the person uncomfortable.

• The interview style is important with emphasis on prevention rather than blame.

• The person(s) should give an account of what happened in their terms rather than the investigators.

INTERVIEWS

Page 62: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• Interviews should be separate to stop people from influencing each other.

• Questions when asked should not be intimidating as the investigator will be seen as aggressive and reflecting a blame culture.

INTERVIEWS

Page 63: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

INTERVIEWS

Interviews are of critical importance. The witnesses may be on guard and very defensive, feeling that blame could be directed their way, so it is important to put the person being interviewed at ease – state that the purpose of the interview is to help determine the facts to prevent a re – occurrence.

Page 64: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Good interview techniques include:

Interviewing witnesses promptly after the event, to avoid lapse of memory or confusion through witnesses discussing with each other.

Conduct the interview in private with no interruptions. Not interviewing more than one person at a time. Protecting the reputation of the people interviewed. Setting a casual, informal tone during the interview to put the individual

at ease. Asking probing questions, but being careful to avoid leading the

witnesses. Recording the details; names of the interviewers, interviewee or anyone

accompanying interviewee’s, place, date and time of the interview, and any significant comments or action during the interview.

Summarizing your understanding of the matter. Expressing appreciation for the witnesses information.

INTERVIEWS

Page 65: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The accident site should be inspected as soon as possible after the accident. Particular attention should/must be given to:

• Positions of people.• Personnel protective equipment (PPE).• Tools and equipment, plant or substances in use.• Orderliness/Tidiness.

OBSERVATION

Page 66: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Documentation to be looked at includes:• Written instructions, procedures and risk assessments which should

have been in operation and followed. The validity of these documents may need to be checked by interview. The main points to look for are:

Ø Are they adequate/satisfactory?Ø Were they followed on this occasion?Ø Were people trained/competent to follow it?

• Records of inspections, tests, examination and surveys undertaken before the event. These provide information on how and why the circumstances leading to the event arose.

DOCUMENTS

Page 67: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

PLANS

Plans can be used to provide a clear indication of the accident scene including position of any injured person, witnesses, plant and equipment. The use of a sketch plan by the investigator, as well as any service or layout plans can assist in determining root causes of the event.

Page 68: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

PHOTOGRAPHS

Cameras can be used to record and preserve images of accident scenes or resulting injuries.This can be especially useful if the situation changes with time through corrective actions, healing process, changes in environmental conditions, etc.

Page 69: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

RELEVANT RECORDS

The amount of time and effort spent on information gathering should be proportionate to the level of the investigation but should include all available and relevant information such as opinions, experiences, observations, measurements, check sheets, work permits, risk assessments, method statements and training records.

Page 70: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Investigation report forms vary in design, layout and content. Different report forms:

A level 1 report – (initial investigations) A level 2 report – (done by other managers,

H&S practitioners) A level 3 report – (done by the investigation

team, not tend to be on a pre-printed format)

CHECKLISTS

Page 71: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Common structure of a report tends to determine: What happened - the loss, How it happened - the event, Why it happened - the causes, immediate

and root causes, Recommendations - corrective and preventive

action.

Drawings, photographs and statements usually support the report as appendices.

CHECKLISTS

Page 72: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

IMMEDIATE AND ROOT CAUSES

Page 73: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

• Collect all information and facts which surround the accident. • Immediate causes are obvious and easy to find. They are brought

about by unsafe acts and conditions and are the ACTIVE FAILURES. Unsafe acts show poor safety attitudes and indicate a lack of proper training.

• These unsafe acts and conditions are brought about by the so called ‘root causes’. These are the LATENT FAILURES and are brought about by failures in organisation and the management’s safety system.

DETERMINING CAUSES

Page 74: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Determine what changes are needed

The investigation should determine what control measures were absent, inadequate or not

implemented and so generate remedial action for implementation to correct this.

Page 75: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

IMMEDIATE AND ROOT CAUSES

(ILO) Code of Practice – Recording and Notifying of Occupational Accidents and Diseases(COP-RNOAD) – 10.2

Requires the employer to, as far as possible:Establish what happenedDetermine the causes of what happenedIdentify measures to prevention a recurrence.

Page 76: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

IDENTIFYING IMMEDIATE CAUSES

The causes of an incident should be identified. Injuries /ill-health are caused by: Unsafe Acts – by individuals, ex.

Not wearing the correct PPE such as eye goggles to prevent eye injury.

Unsafe Conditions – in the workplace, ex. An electrical cable, supplying energy to a power tool, trailing across a busy walkway and presenting a trip hazard.

Page 77: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

ROOT OR UNDERLYING CAUSES

The causes of the incident are often the result of many underlying or root casual failures.

Typical root or underlying causes result: When people lack of understanding or training,

they are in a hurry and they are poorly supervised.

When the wrong equipment is provided or the equipment is inadequate, not maintained or regularly inspected.

Page 78: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

ROOT OR UNDERLYING CAUSES

Lack of Management ControlLack of Management Control

Indirect CausesIndirect Causes

Immediate CausesImmediate Causes

Loss or InjuryLoss or Injury

AccidentAccident Near MissNear Miss

DOMINO THEORY

Page 79: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

ROOT OR UNDERLYING CAUSES

“LOSS”This is the consequence of the accident and can be measured in terms of people (injuries), property (damage) or loss to the process (failed telecommunication) and hence loss of profit.

Page 80: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

“EVENT”(incident or accident)

The event producing the loss involving contact with a substance or source of energy above the threshold limits of the body or structure.

ROOT OR UNDERLYING CAUSES

Page 81: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

“IMMEDIATE (direct) causes”

This are the Substandard (unsafe) Acts

(ex. Using tools and equipment for tasks they were

not designed to) and

Substandard (unsafe) Conditions

(ex. A trailing telephone cable in an office) which

give rise to an accident.

ROOT OR UNDERLYING CAUSES

Page 82: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

“INDIRECT” (root or underlying) causes- This are the underlying or root causes of

incidents. Identifying the root causes will explain why the substandard act happened or the condition arose.

They are not always easy to identify and falls into three categories:1. Organizational factors2. Job factors3. Personal factors

ROOT OR UNDERLYING CAUSES

Page 83: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

“Lack of management control”This is the initial stage, centered on the management functions of:

1. Policy2. Planning3. Organizing4. Controlling5. Monitoring 6. Reviewing

ROOT OR UNDERLYING CAUSES

Page 84: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Recording & Analysing the Results

• Recorded in a similar and systematic manner.• Provides a historical record of the accident.• Analysis of the causes and recommended

preventative protective measures should be listed.

• Completed as soon after the accident as possible.

• Information on the accident and remedial actions should be passed to all supervisors.

• Appropriate preventative measures may also have to be implemented by such supervisors.

• Investigation reports and accident statistics should be analysed from time to time to identify common causes, features and trends not be apparent from looking at events in isolation.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

Page 85: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Reviewing the ProcessReviewing the accident/incident investigation process should consider:– The results of investigations and analysis.– The operation of the investigation system (in

terms of quality and effectiveness).

Line managers should follow through and action the findings of investigations and analysis. Follow up systems should be established where necessary to keep progress under control.

Deal with immediate risks.

Select the level of investigation.

Investigate the event.

Record and analyse the results.

Review the process.

Page 86: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Remedial Actions

Page 87: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Generally, remedial actions should follow the hierarchy of risk control:

• Eliminate Risks by substituting the dangerous by the inherently less dangerous.

• Combat risks at source by engineering controls and giving collective protective measures priority.

• Minimise risk by designing suitable systems of working.• Use PPE as a last resort.

REMEDIAL ACTIONS

Page 88: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Immediately after the accident: Attend to the victim Notify the next of kin Secure the scene of accident Report to enforcing authority if necessary

Longer term actions include: Identifying witnesses Undertaking an investigation Reviewing work procedures

REMEDIAL ACTIONS

Page 89: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Reporting a death arising from work should include informing: The top Manager Health and Safety Practitioner Coroner, court or police Enforcing and competent authority Next of kin Worker representatives Other workers Insurance company

REMEDIAL ACTIONS

Page 90: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REPORTS AND FOLLOW – UP

The report should include a summarized version of the facts and recommendation of remedial action, together with discussion of controversial points and if necessary appendices containing specialist reports (medical and technical), photographs and diagrams.

Page 91: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

The investigation system should be examined from time to time to check that it consistently delivers information in accordance with the stated objectives and standards. This usually requires:

• Checking samples of investigation forms to verify the standard of investigation and the judgements made about causation and prioritisation of remedial actions.

• Checking the numbers of incidents, near misses, injury and ill-health events;

• Checking that all events are being reported.

UPDATING THE SYSTEM

Page 92: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

SUMMARY

Throughout the process of investigation it must be clearly borne in mind that the objective is to prevent a recurrence of the accident, not to apportion blame. It is important to identify the true causes of the accident, not superficial ones. This cannot be achieved without the full commitment and assistance of witnesses and other persons who work in the area that the accident happened. It follows that recommendations must be put into action, even though they may take a considerable amount of time, trouble and money.

Page 93: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

Outline the benefits to an employer of conducting accident investigation. (8)

Page 94: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

A machine has leaked hot liquid into a work area. No one has been injured.

Outline reasons why it is important for an organization to investigate ‘near miss’ incidents. (8)

04/18/2023

Page 95: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

A worker has been seriously injured after being struck by a reversing vehicle in a loading bay.

Give FOUR reasons why the accident should be investigated.

(4)Outline information that should be included in the investigation

report. (8)Outline: – FOUR possible immediate causes. (4)– FOUR Possible underlying (root) causes of the accident. (4)

04/18/2023

Page 96: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

4.3 RECORDING and REPORTING

ACCIDENTS

Page 97: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REPORT FORM TYPESA number of report forms are utilized to identify and inform that incidents have occurred.These include: Initial record of incident, ex. Accident book First – aid treatment reports Medical treatment reports Medical (doctor) reports of ill – health Sickness absence reports Event (incident/accident) reports Event (near miss) reports Maintenance /repair reports Insurance reports Reports of incidents to competent authority

Page 98: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REPORTING ROUTES

Reporting of an accident or ill – health may be by a number of means and includes: Person receiving harm Person causing loss Person discovering loss

Page 99: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Reporting of Events

to External Agencies

Page 100: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REPORTING OF EVENTS

Occupational accident“an occurrence arising out of, or in the course of, work which results in: ex. (a) Fatal and (b) non – fatal occupational injury”

Commuting accident“an accident occurring on the direct way between the place of work and: ex. (a) worker’s principal or secondary residence, (b) place where the worker usually takes their meals, (c) place where workers usually receives their remuneration, which results in death or personal injury involving loss of working time.”

Page 101: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

REPORTING OF EVENTS

Occupational disease“a disease contracted as a result of an exposure to risk factors arising from work activity.” ex. asbestosis

Dangerous occurrence“readily identifiable event as defined under national laws and regulations with potential to cause an injury or disease to persons at work or the public.” ex. Scaffolding collapse due to strong wind

Page 102: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

MAJOR INJURIES

List of major injuries to be reported: Any fracture, other than the finger or thumbs or

toes, Any amputation, Dislocation of the shoulder, hip, knee or spine, Permanent or temporary loss of sight, Chemical, hot metal or penetrating eye injury, Electrical shock, electrical burn leading to

unconsciousness, resuscitation, admittance to hospital for more than 24hrs.

Page 103: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

Loss of consciousness caused by asphyxia or exposure to a harmful substance or biological agent.

Acute illness or loss of consciousness requiring medical attention due to any entry of substance by inhalation, ingestion or through skin.

Acute illness where there is a reason to believe that this resulted from exposure to a biological agent or its toxins or infected materials.

Any other injury leading to hypothermia, heat induced illness or unconsciousness requiring resuscitation, hospitalization greater than 24hrs.

MAJOR INJURIES

Page 104: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

DISEASES

Diseases by Agent Physical agents Chemical agents Biological agents and infections or parasitic diseases

Diseases by target organ system Respiratory diseases Skin diseases Musculoskeletal disorders Mental and behavioral disorders

Page 105: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

OCCUPATIONAL CANCER

Cancer caused by agentsThis includes: Asbestos Mineral oil Benzene Wood dust

Page 106: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

DANGEROUS OCCURRENCES

Incidents that have the potential to cause death or serious injury and so should be reported, even though no one is injured.Ex. Collapse or failure of lifting equipment Failure of a pressurized closed vessel Collapse of a building Explosion Fire

Page 107: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

A worker has been seriously injured in an accident at work.

Outline the immediate and longer term actions that should be taken. (8)

Page 108: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

a) A) Outline why an organization should have a system for the internal reporting of accidents. (4)

B) Identify why workers might not report accidents at work. (4)

Page 109: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

a.)Identify FOUR reasons why accidents should be reported and recorded within a workplace. (4)

b.) Identify factors that might discourage workers from reporting workplace accidents. (4)

Page 110: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

EXAM QUESTION

a.) Outline the meaning of the terms: ‘active’(proactive) monitoring; (2)

‘reactive’ monitoring (2)b.) Outline TWO active (proactive) monitoring methods that can be used when assessing an organization’s health and safety performance. (4)

Page 111: IGC-1 Element 4 Ver 1.0 Updt 7-6-15

THE END