Accident Investigation.ppt

7/24/2019 Accident Investigation.ppt

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Approach:-Every accidentrepresents a systemfailure and an opportunity

to improve management

system


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Why: -

An important step towards accident prevention.

A minor incidence or a near miss accident will

give direction for preventing further recurrence

of major accident which may not be possible byseveral safety inspections.

People get motivated to implement safety

improvement after an accident.

All safety rules formulated are the result of

accident investigation.


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Objective: -

Every accident investigation

must result in at least onerecommendation to improve

the MAA!EME"#$#"EM


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Who:-

Every accident must be investigated by the firstline supervisor.

%eportable accident to be investigated by the first

line supervisor and his one step up authority.

#erious accident to be investigated by all the

above and higher management.

#afety professional should investigate selectedaccident irrespective of whether major or minor.


7/19

When: -

Immediately for minor accident.

Immediately after the injured person is sent

for treatment in case of serious accident.

Where: -

On the spot of accident as-

1)Investigation process becomes fast.

2)ll the evidences are present on the spot of

accident.


8/19

!o":-

&raw process chart of the process duringwhich accident too' place

(ollect information related to

-PPE) Machine) E*uipment)Environmental (ondition)

+njured Person) ,ob Procedure)

Ma'e use of fishbone diagram

ind out deviation) decide corrective action

and +mplement the same.


9/19

What is fishbone diagram#

+t has come from ,apanese culture of *uality

circle. "he original name is +shi'awa/ diagram.

+t is 'nown as (ause and Effect/ or ishbone/

diagram in English. 0ecause of some causes

related to man) machine) material) method)

management and money *uality gets

deteriorated. ind out the causes and ta'eremedial measures. "he same diagram is

converted to suit accident investigation process.


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1riginal fish bone diagram: -

$ause %ffect &eterioration in 'uality

(an (achine (aterial

(ethod (oney (anagement


11/19

$ause %ffect ccident

ersonal rotective

%'uipment

%nvironmental

$onditions

(achine * e'uipment

Injured erson (anagement +ob rocedure

-2hich PPE was specified3

-2as the PPE available3-was the PPE in condition3

-2as the employee

trained in use of PPE3

-2as the PPE properly used3

-2as his posture correct3

-2as his education

Ade*uate3

-2as he physicallyunsuitable for job3

-2as he under

stress4habitual absentee

-2as the machine

defective3

-2as defect noticed4

reported 3

-+nspection

Procedure3

aulty M4c

design3

-2as job

procedure

e5isting3

-&id job procedure

cover 6(46A3

-2as job procedure

e5plained 4understood3

2rong substitute3

-2as supervisor

trained for safety3

-2as there a failure

to detect ha7ard3

-2as there a failure

to correct 6()6A)

8a7ard

-(ondition of floor4 Aisle3

-9entilation) illumination3

-oise level3 #ilent &!

-#ufficient wor' space3

-Presence of dust4smo'e3

ight wor' whetherreally re*uired.


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While investigating an ccident:-

-!o to the spot of accident-$our attitude should be A(" +&+! and

not A6" +&+! or 0AME +;+!

-(ounteract any feeling of guilt that anyone might

have-&raw map of scene

-+nterview all witnesses separately

-"ry to get people open up so *uestions li'e


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,$%%//0%//,

0ot a cause of accidents

1ften people ma'e such statements as Eighty percent ofall accidents are due to (arelessness./ +t is unfortunate that

many persons thin' that this statement is true.

+n reality Carelessness is not a cause of accidents.+nstead it is an alibi for industrial e5ecutive) foremen and

others who unthin'ingly placing the blame on the wor'er

who are injured.+t serves as a boomerang too) for its use

condemn the person who uses it. +t is an unthin'ingadmission on his part that he is ma'ing little or no effort to

control the carelessness of the wor'er.

-Mr. . &ean >eefer


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Investigators kit

1.Digital Camera with flash

2.Measuring tape3.Clip board, writing pad

4.Pen, pencil

5.ccident !n"estigation form

#.Chec$ list% fishbone diagram&.'lash light ()atter*+ 'lame proof if necessar*

-.mall plastic bags

/.0ooth brush% cotton waste% cloth for cleaning

1.nife

11.!nspection mirror12.Magnif*ing glass

13.Permanent mar$er% chal$

14.0ool bo with screw dri"ers, spanner etc,

15.Drin$ing water


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Gathering Evidences:

e ha"e to use four P approach means

1.People

2.Position

3.Parts

4.Paper

People:6ecollection of witnessesupporti"e e"idence from other people who ha"e rele"ant

$nowledge regarding the occurrence

Getting Knowledge of Evidence from people : -7"idence in the minds of people gets contaminated "er*

fast. 8ence inter"iewing should be done as immediate as

possible.memor* and willingness to tal$ can be affected b*

inter"iewer9s techni:ue. i.e.


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!nter"iew witnesses separatel*;et the indi"idual9s "ersion as he remembers.ects, li:uids, gasescan be scientificall* anal*?ed to identif* substances, forces,

patterns and stresses etc.


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Papers:

6ecords, logs, procedures, programs, and other documents

@ ma* be computeri?ed.

it is durable e"idence. !t ma* not get contaminated.will be helpful in genrating bac$ground information

fter collecting the evidences

Analy7e all the evidenceind out root causes#uggest remedial measures and ------

I(%(%0 !%

%(%&I (%/%/


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With reference to O!// 13441

Incident Investigation:

"he organi7ation shall establish) implement and maintain a procedure?s@ to

record) investigate and analy7e incidents in order to:

a@&etermine underlying 18# deficiencies and other factors that might be

causing or contributing to the occurrence of incidentsB

b@+dentify the need for corrective actionB

c@+dentify opportunities for preventive actionB

d@+dentify opportunities for continual improvementB

e@(ommunicate the result of such investigationsB

"he investigation should be performed in a timely manner.Any identified need for corrective action and opportunities for preventive action

#hould be implemented as decided.

"he resulft of incident investigation shall be documented and maintained.


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Date post:	21-Feb-2018
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Accident Investigation.ppt

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