6. Accident Investigation

PURPOSE

The purpose of incident/accident reporting and investigations is to prevent a recurrence of the hazardous condition causing the event.

DEPARTMENTAL REQUIREMENTS – Department of Chemical and Biological Engineering

The WCB requires the Department of Chemical and Biological Engineering to investigate any accident which:

  • resulted in injury requiring treatment by a medical practitioner
  • resulted in death or critical condition with a serious risk of death
  • involved a major structural failure or collapse
  • involved the major release of a toxic or hazardous substance
  • was a blasting or diving accident
  • did not result in an injury but had the potential for causing serious injury (near miss).

The Department of Chemical and Biological Engineering is also required to report to the Department of Health, Safety and Environment (HSE) every:

  • work-related injury. The report must be made within 24 hours of the occurrence.
  • disabling occupational disease or allegations of an occupational disease. The report must be made within 24 hours of receiving the worker’s report of the disease.
  • work-related death. The report must be made immediately.

The HSE Department is responsible for reporting this information to the WCB.

To meet these requirements, the Department of Chemical and Biological Engineering has developed and implemented a program for the reporting and investigation of accidents. The Program’s focus is on finding solutions and not on placing blame. The success of the program depends on:

  • accidents being reported by workers (see accident/incident report forms)
  • investigations being conducted in accordance with established investigation procedures corrective action taken to prevent recurrence.

Investigation teams consisting of an area supervisor and an employee representative will perform investigations. Each investigator is required to be trained on investigation procedures as well as be knowledgeable of the work performed at the time of the accident.

The Department of Chemical and Biological Engineering supervisors and worker representatives assigned to conduct investigations are:

NAME

TITLE

UNIT

Supervisors:    
Head of the Safety Committee and two appointed representatives    
     
Worker Representatives:    
One of the appointees    

Management will provide all tools and resources necessary for the Program to be effective. These include:

  • accident investigation training for investigators
  • time made available to allow investigators to complete their duties
  • quick action on recommended changes to job procedures or physical conditions to prevent recurrence of similar situations.

Incident / Accident Reporting Instructions

accidentreport

Incident + Accident Reporting Instructions

Accident Investigation Procedures

Preparation

As a measure of preparedness, always have a ready-to-use Investigation kit prepared and available in advance. The kit should contain the following items:

  • clipboard
  • notepad
  • pens/pencils
  • measuring tape
  • camera, film, flash
  • accident investigation forms
  • flashlight
  • do-not-enter tape.

Gathering Information

  • Enter the accident scene cautiously.
  • Ensure the injured are cared for properly before starting the investigation.
  • Secure the scene to minimize the risk of further injury.
  • Keep the accident scene as undisturbed as possible.
  • If possible, take pictures of the scene or provide a diagram to aid in better describing the accident.
  • Gather and record all evidence.
  • Interview all persons involved (injured person, witnesses, first aid attendant, supervisors, etc.)
  • See interviewing techniques on next page.

Evaluation

  • Be objective – do not start with a fixed opinion.
  • Set out the events in chronological order.
  • Consider what evidence is direct, circumstantial or hearsay.
  • Analyze the information to determine the root cause(s) and the contributory cause(s).
    • ROOT CAUSE – if this did not happen, then the particular accident would not have occurred.
    • CONTRIBUTORY CAUSE – this could have caused the accident, but by being removed will not eliminate the chance of the accident occurring.
  • Do not draw conclusions on the first basic cause found.
  • Make recommendations to address all contributing factors. Solutions should be developed to treat the basic causes of the accident, not the symptoms.

Post-Investigation

  • Complete the Accident Investigation Report.
  • Submit a copy of the completed Accident Investigation Report to the Faculty Safety Program Administrator for review and distribution.
  • Correct any unsafe condition or act if possible. Make sure temporary safety measures are taken whenever permanent or complete correction will require additional time. For items that require a major expenditure, write an explanation of the hazard and include a description of the impact of further accidents.
  • Post a copy of the Accident Investigation Report form in an area accessible by all departmental staff.

Investigation Follow-Up

  • For all hazards, ensure that corrective action or control has been taken.
  • Be persistent and regularly follow-up on items that require corrective action. Consult the local Safety Program Administrator when necessary.
  • Periodically review corrective actions or control methods.
  • Ensure all reports are properly posted, distributed and filed.

Interview Techniques

  • Interview persons individually and as soon as possible after the accident.
  • Put the interviewee at ease by reassuring him/her that the investigation’s main purpose is to find causes so that the accident will not happen again. The investigation is not to find fault or blame and that he/she will not get in trouble for anything that they say.
  • Ask the interviewee to relate his/her account of the accident. Listen closely and carefully, and do not interrupt at this time.
  • Ask the interviewee to relate his/her account of the accident again and this time take notes. Explain to the interviewee that you will be taking down notes to ensure that the report will be related correctly. Allow the interviewee to see what is written down.
  • Ask only necessary and specific questions in a friendly constructive manner. Phrase each question in a way that cannot be answered simply with a yes or no. Avoid any leading questions.
  • Review the recorded notes with the interviewee to ensure the interviewee agrees with the interpretation of his/her story.
  • Ask the interviewee for his/her suggestion on how the accident could have been prevented.
  • Encourage the interviewee to contact you if he/she should recall more information at a later date.
  • Always thank the interviewee for his/her cooperation and reassure him/her that his/her assistance is important to the investigation process.

Accident Investigation Forms

UBC Faculty and Staff Incident + Accident Report Form

UBC Student and Visitor Incident + Accident Report Form