Accident&IncidentInvestigationAnoverviewofinvestigatingaccident&incidentsforlinemanagers&supervisorsSETTINGTHESCENECarryingoutyourownhealthandsafetyinvestigationswillprovideyouwithadeeperunderstandingoftherisksassociatedwithyourworkactivities.Blamingindividualsisultimatelyfruitlessandsustainsthemyththataccidentsandcasesofillhealthareunavoidablewhentheoppositeistrue.UniversityofBathWHYINVESTIGATEACCIDENTS?Thedriversthatmakeinvestigationimportant•Compliancewiththelaw–Thelawrequiresthatwemanagehealth&safetyriskseffectively;thisincludesmonitoringhealth&safetyperformance•Managingandcontrollingfinanciallosses–Accidentandincidentscosttime,money&resources;onlyasmallfractionofaccidentlossesarecoveredbyinsurance•Compliancewithmoralexpectations–Accidentscausepain,sufferinganddistresstoworkersandtheirfamilies;ourstakeholdersexpectustopreventthisUniversityofBathWHOSHOULDINVESTIGATEACCIDENTS?Whoneedstobeinvolvedandwhatskillsdotheyneed•Monitoringhealth&safety(includingaccidentinvestigation)isalinemanagementresponsibility•Investigationsshouldinvolvebothmanagersandtheworkforce.Potentialpartnersinaninvestigationare:–SeniorManagers,LineManagers&Supervisors–Health&SafetyAdvisers&SpecialistTechnicalAdvisers–UnionSafetyRepresentatives&EmployeeRepresentatives•Apartnershipwillcombinepracticalknowledge&experience.–Health&safetygoodpractice–Standards&legalrequirements–Investigativeskills–interviewing&collectingdata–Criticallyevaluatingevidence•SufficienttimeandresourcesareneededtocarryoutaninvestigationUniversityofBathWHATSHOULDBEINVESTIGATEDWhatadverseeventshouldbeinvestigated?UNDESIRABLENEARMISSACCIDENTasetofconditionsorcircumstancesthathavethepotentialtocauseinjuryorillhealthaneventthat,whilenotcausingharm,hasthepotentialtocauseinjuryorillhealthaneventthatresultsininjuryorillhealthLEVELOFINVESTIGATIONHavingbeennotifiedofanadverseeventandbeengivenbasicinformationonwhathappened,youmustdecidewhetheritshouldbeinvestigatedandifso,inwhatdepth.Itisthepotentialconsequencesandthelikelihoodoftheadverseeventrecurringthatshoulddeterminethelevelofinvestigation,notsimplytheinjuryorillhealthsuffered.UniversityofBathLEVELOFINVESTIGATIONHowmuchefforttodevotetoaninvestigation•Balancetheeffortexpendedagainstthepotentialbenefits.Consider•LIKELIHOODthattheeventwillhappenagain•LikelyWORSECONSEQUENCEifitdoesMINORSERIOUSMAJORFATALRAREMINIMALLOWMEDIUMHIGHUNLIKELYMINIMALLOWMEDIUMHIGHPOSSIBLELOWMEDIUMHIGHHIGHLIKELYLOWMEDIUMHIGHHIGHCERTAINLOWMEDIUMHIGHHIGH<11590250UniversityofBathLEVELOFINVESTIGATIONHowdeepshouldtheinvestigationdrill?LEVELWHOIMMEDIATEPremises,plant&substances,procedures,peopleUNDERLYINGPlanning,riskassessmentUNDERLYINGOrganisation,monitoring,reviewROOTPolicyissues,resourceallocationMINIMALDEPARTMENTYESMAYBELOWDEPARTMENTYESYESMAYBEMEDIUMUHSEYESYESYESMAYBEHIGHUHSE/UHSELEDTEAMYESYESYESYES•Itisimportantthataccidentinvestigationsareclearlydelegated•Itisimportanttosetsomeboundary'sonaninvestigation–otherwiseinvestigationscandragonforeverandexpandtoexamineeverythinginminutedetail–forlittlebenefitUniversityofBathLEVELOFINVESTIGATIONWhatshouldaninvestigationachieve?Theprimarypurposeofanaccidentinvestigationistoimprovehealth&safetyperformance–itisn’ta“prosecution”process•Information&insightsfromaninvestigation–Whatwentwrongandwhy–Asnapshotofhowworkisactuallycarriedout–Identificati...
