When an incident is reported, the team leader will receive an email notification. Click on the link in the email and read the incident report. You need to decide if:
- An investigation is needed – assign the report to the relevant inspector who will receive a notification and make arrangements with the OMC to carry out the investigation
- No investigation is needed – close the report
Data for open and closed reports is stored in the Proactively system for analysis.
Which incidents need to be investigated?
The following must be investigated:
- All Fatalities: Work related incidents which result in the death of any person, including non workers, must be investigated.
- ‘incident’ excludes suicides and deaths from natural causes.
- Deaths caused by ill health which have a preventable work-related cause and there is the likelihood of a serious breach of Health and safety standards are included
- Incidents which indicate a likelihood of a serious breach in health and safety standards or the condition of the licence.
- Incidents which had the potential to cause multiple fatalities
- When there has been a large number of similar incidents
The following may be investigated:
Consider incidents where you can get the most learning:
- How likely is the incident to happen again, at this company or any other company? For example, you may have already seen several reports of similar incidents. In the table below this is scored
- Certain – something similar to this incident is very likely to happen again, either at this company or another company eg. 10 times per year
- Possible – something similar may happen again, eg. twice a year
- Unlikely – you would not expect this sort of incident to happen again
- What is the worst possible outcome of the incident? The report shows the actual outcome, but perhaps it could have been worse? Were they lucky? For example, a car collides with a cyclist, this time the cyclist was lucky and had only minor injuries needing first aid, but it could easily have resulted in a fatality. This is scored:
- Fatality – one or more people could have died
- Serious – one or more people needed to go to hospital for treatment, or needed to take more than 1 day off work to recover from an injury
- Minor – only first aid was needed.
Now look at where the incident sits in this table:
What colour is the box?
- Red – an investigation is needed. Assign this report to an inspector.
- yellow – an investigation may be needed. Consider,
- Was a member of the public was involved? If yes, it is good practice to investigate.
- Has the company already taken actions to stop the incident happening again? If no actions or insufficient actions have been taken, an investigation could be helpful.
- blue – no investigation is needed – close the report
Type of inspection
The inspector gets an email when he is assigned an investigation. He clicks the link to read the report. The inspector decides what sort of inspection is needed.
The questions to ask include:
- Who are you talking to and when
- Tell me what happened?
- Why did this happen?
- What are you doing to stop it happening again?
Write notes in the report.
- Click on the link in the email to open the incident report
- Choose notes from left menu
- Write notes during the phone conversation
- Click save
From the answers, the inspector decides if a site visit is needed, or to close the report.
Call the OMC to arrange a time for the visit. It is important that:
- They leave the area where the incident happened unchanged. They should not try to clean up so evidence is preserved.
- Any relevant documentation is available
- The right people are available. Involving more people reinforces the message that the investigation is for the benefit of everyone. Include:
- A senior manager to help with the investigation. He has the authority to make decisions and take action.
- People involved in the incident, including witnesses, workers and supervisors are available for interview.
- People with detailed knowledge of the work activities involved. Employee safety representatives or trade union officials may also be interviewed, if present.
This joint approach ensures that a wide range of practical knowledge and experience is consulted to make sure the findings are correct. Involving lots of people will help them feel empowered and supportive of any remedial measures that are necessary.
During the site visit, use the investigation form in Proactively to collect the required information.
When should you investigate?
Aim to investigate all incidents as soon as possible. This is when people will have the best memory about what happened, and the greatest motivation.
The urgency will depend on the magnitude and immediacy of the risk (eg. a major accident involving an everyday job will need to be investigated quickly)