Conducting
an Accident Investigation
Course 102
Safety Certified Supervisor Series
MODULE 7: WRITING THE REPORT
The Accident Report
Form
- Section I.
Background
- Section II.
Description of the accident
- Section
III. Findings
- Section IV.
Recommendations
- Section V. Summary
- Section VI.
Review and Follow-Up Actions
- Section VII.
Attachment
Section III. Findings
(continued)
- Sample primary
surface cause finding statements
- Sample secondary
surface cause finding statements
- Sample safety program implementation
root cause finding statements
- Sample safety program design
root cause finding statements
These findings describe those conditions
and behaviors produced by individuals at some point prior to the injury event.
These conditions, activities, practices and behaviors can exist at any time,
in any place, and be produced by any person in the organization.
- Hazardous condition: Tools
to repair the machine guard were broken and unusable.
- Unsafe behaviors: An
employee (could not be determined who) failed to replace bolts on the guard.
An employee defeated the guard by cutting through the guard grating producing
a large hole. The injured employee had not been trained in chipper operation
or machine guarding principles.
