How to Improve Your Accident Investigations

By LaBar, Gregg | Occupational Hazards, March 1990 | Go to article overview

How to Improve Your Accident Investigations


LaBar, Gregg, Occupational Hazards


HOW TO IMPROVE YOUR ACCIDENT INVESTIGATIONS

Are your accident and incident investigations doing their job? They should be finding underlying causes and helping you to prevent other, more serious accidents.

Accidents don't just happen. They're caused [not just by people, but by conditions and other factors], and every one of them has to be investigated," says Frank E. Bird Jr., president of the International Loss Control Institute (ILCI) and an author and consultant on the subject of accident investigations. (For this article, an accident is defined as unwanted contact with energy or a substance above the threshold limit of the body or structure that results in adverse effects.)

According to Bird, companies need a written accident investigation policy and a good accident investigation program no matter what their safety records are (in other words, no matter how often they have accidents). Companies just starting out, or those wishing to improve their safety records, can use accident investigations to focus on problems. Established companies with even minuscule accident rates need investigation programs to track so-called "near-misses" and to be prepared for infrequent accidents, Bird notes. Furthermore, he says, the existence of a good program is often an indication of overall sound safety management.

Unfortunately, according to Bird, some accident investigation programs degenerate into "finger-pointing, blame-fixing, and fault-finding exercises." Instead, he says, they should be used to find real, underlying causes, identify trends, and point out possible corrective action.

When to Investigate

Bird says simply, "Every accident has to be investigated." This obviously includes major accidents and other lost-time cases. In addition, Bird notes, there should be more than just a sigh of relief at the occurrence of the much more prevalent "near-misses" -- minor incidents that could have been accidents had it not been for luck (i.e. an object being lifted by a crane falls to the ground but causes no injury or damage because employees and equipment had just been moved out of the way). Near-misses are, Bird says, indications that something's wrong and, therefore, need to be investigated with vigor.

Nick Pacalo, chairman of the Safety Sciences Department at Indiana University of Pennsylvania (IUP), Indiana, Pa., says the near-misses should be viewed as "opportunities" to examine and correct problems before a serious accident occurs. "If we look at incidents, we may be able to prevent the big accident," Pacalo tells students taking his accident investigation course.

Mike Squillace, manager--occupational safety services for the Minnesota Safety Council, St. Paul, observes that companies with excellent safety records often have very active, not dormant, accident investigation programs. "They have a trigger point that is catching the near-misses," he says. "From the outside, you don't see this because they aren't recordables. But, inside, you find a lot of accident investigations going on for minor incidents to prevent the big accident."

Safety manager Dan Moe says his company, The Quaker Oats Co., Chicago, spends time investigating near-misses, "even first aid incidents that could have been worse or that indicate a larger problem." Moe uses this example: A worker suffers a minor injury when some dust gets in his eye while he's using a grinder to do maintenance work. To the trained accident investigator, this might point out a more serious problem, such as personal protection not being worn or the wrong equipment being used.

For every injury, accident, near-miss, and first aid case in Quaker Oats' facilities, an internal report is generated. The information is then entered into a computer that tracks incidents based on some 75 factors, including department, type of machine, body part affected, type of injury, and causes.

Naturally, not all accidents are treated with equal time, effort, and personnel. …

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