Originator Date Section ID Description of Change Reason for Change

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1 MANAGEMENT PROCEDURE Author : P.D Govender Date of Recommendation: Date of Acceptance: Distribution: -Health & Safety Committee - All Personnel BREEDE VALLEY FIRE & EMERGENCY SERVICES DCN: BVFES/HSE/FSMA/SOP/IRP/2005 ISSUE NO:1 REV. 0 INCIDENT REPORTING PROCEDURE Approved by Chief: Fire Services DOCUMENTATION HISTORY Issue & Revision Originator Date Section ID Description of Change Reason for Change 1 PD Govender 01/07/05

2 BVFES INCIDENT & ACCIDENT REPORTING PROCEDURE DCN: BVFES/HSE/FSMA/SOP/IRP/2005 Date Originated: 01 /08/05 Last Review: 01/08/05 Issue no: 1 Pages: 1 of Purpose & Scope To ensure that all employees are aware of how to report all incidents and accidents and the investigations that are likely to take place. 2.0 Responsibilities 2.1 All members of staff 2.2 Health & Safety Committee 2.3 Fire Department Safety Officer 2.4 Municipal Occupational Safety Officer 3.0 Related Documents 3.1 Regulations 6 and 8 of General Administrative Regulations to the OHS Act. 3.2 Section 24 of the Occupational Health & Safety Act 85/ Department of Labour Form Annexure 1 Reporting of Section 24 incidents 3.4 Department of Labour Form Annexure 2 Recording and investigating of Incidents. 3.5 Workman s Compensation Commissioner Form W.CL2A Employers Report of an Accident. 3.6 BVFES Injury on Duty Policy 4.0 Definitions 4.1 Accident: Any incident in which a person (employee, visitor, etc.) is killed or injured. 4.2 Disabling injury: An injury in which the person s injury necessitates his losing more than one completed shift, or is injured to the extent where he cannot continue with his normal job function. 4.3 Incident: Any occurrence, which could or has resulted in any loss or damage to any property or equipment, 4.4 Minor Injury: An injury that needs first aid treatment only and the person can return to work immediately. 4.5 Near Miss: Any occurrence, which could have resulted in any loss, damage or injury to any property, equipment or person. 4.6 Reportable Injury: An injury where the person s injuries are within the parameters of Section 24 of the Occupational Health & Safety Act and it is compulsory to report the injuries to the Divisional Inspector in the Department of Labour. 4.7 Section 24: Each of the following incidents must be reported to the Inspector: - If a person dies, may die, or suffer permanent disability, becomes unconscious, suffers loss or partial loss of a limb, or after 14 days cannot come back to work to do the same job he was doing prior to the accident. - Any major incident that has occurred. - The health and safety of a person was endangered when a dangerous substance was spilled, there was uncontrollable pressure release of any substance, and machine failure resulted in flying, falling or uncontrolled movement of objects.

3 BVFES INCIDENT & ACCIDENT REPORTING PROCEDURE DCN: BVFES/HSE/FSMA/SOP/IRP/2005 Date Originated: 01 /08/05 Last Review: 01/08/05 Issue no: 1 Pages: 2 of Procedure 5.1 All incidents and accidents, no matter how minor will be reported by an employee, visitor, etc. to the employee s supervisor or Health & Safety Representative. 5.2 All incidents or accidents will be reported before the end of the working shift on which they occurred. 5.3 The Incident Report Form must be completed by the employee s superior and handed to the employer. 5.4 The Chief Fire Officer (CFO) will arrange for an internal investigation of the incident or accident by the Fire Department Safety Officer, Health & Safety Representative and/or Municipal Occupational Safety Officer. 5.5 The CFO will then arrange for an internal inquiry to take place to determine the cause of the incident or accident and to agree steps to be taken to eliminate or reduce a reoccurrence. 5.6 The internal inquiry committee may consist of the following persons: The CFO or a person so designated by the CFO Health & Safety Representative Organized Labour Representative Municipal Occupational Safety Officer Labour Relations Officer. 5.7 If the inquiry relates to an accident the injured person should be present as part of both the internal investigation and inquiry. However, if it is a disabling injury and he/she cannot be present, the investigation and inquiry must go ahead to determine the cause of the accident and remedial action. 5.8 If necessary, the injured person can be interviewed / questioned over the telephone. 5.9 The internal inquiry can be reconvened to discuss its findings with the injured person on his return to work 5.10 The recommendations will be recorded in the Incident / Accident Investigation Report Form If the accident is a minor accident, the matter will be referred to the Heath & Safety Committee for consideration without the need for any further paperwork If the accident is a disabling injury then the employer must complete an Annexure 2 Form in as much detail as possible. The Annexure 2 must be kept on the premises for inspection by an Occupational Health & Safety Inspector The Annexure 2 will eventually be referred to the Heath & Safety Committee meeting for discussion.

4 BVFES INCIDENT & ACCIDENT REPORTING PROCEDURE DCN: BVFES/HSE/FSMA/SOP/IRP/2005 Date Originated: 01 /08/05 Last Review: 01/08/05 Issue no: 1 Pages: 3 of If the injured person required medical treatment from a doctor or at a medical facility, a W.CL2A Form must be completed in duplicate and one copy must accompany the injured person and be handed to the Doctor or Hospital on the initial visit. The original copy must be sent to the Human Resources Department If the accident is a reportable injury in terms of section 24 of the Occupational Heath & Safety Act, then an Annexure 1 form will also be completed by the Employer and will be sent to the Divisional Inspector, Occupational Health & Safety division at the Department of Labour The Divisional Inspector will decide whether his department wishes to conduct an independent enquiry into the incident or accident If the Divisional Inspector decides on an independent investigation, an Inspector delegated by him to investigate will advise the employer of the date of the investigation The Inspector will advise whom he wishes to be present, but it will include: The employer Injured person Health & Safety Representative Supervisor / Manager / etc Engineer (if machinery is involved) Any witnesses 5.19 The Inspector will conduct his investigation and may make one of two decisions: Close the matter as he is satisfied there was no contravention of the law Order a formal inquiry to further determine whether to prosecute the company or not The outcome of the external investigations will be discussed at the Health & Safety Committee meeting.

5 Appendix A - BVFES/HSE/FSMA/SOP/IRP/2005 INCIDENT REPORTING PROCEDURE INCIDENT / ACCIDENT OCCURS REPORTED TO EMPLOYER REPORTED TO HEALTH & SAFETY REPRESENTATIVE MUNICIPAL OCCUPATIONAL SAFETY OFFICER INTERNAL INVESTIGATION /INQUIRY H&S Representative Employer Other Expert MINOR INCIDENT DISABLING [Lost Time] INCIDENT [IOD] Reportable Accident [Sec. 24 OHSAct] Fill in BVFES Incident Report Form PROCEDURE TO BE : Human Resources FOLLOWED AS PER Fill in the ffg: Department INJURY ON DUTY POLICY 1. IOD Policy Annexures 2. WCL Forms Incident Report Annex 6 Safety Officer Report BVFES H&S Committee DOL Inspector External Investigation EMPLOYER

6 Appendix B - - BVFES/HSE/FSMA/SOP/IRP/2005 Incident / Accident Investigation Report FOR OFFICIAL USE: Incident Ref. No: PART A: REPORT SECTIONS 1 4 TO BE COMPLETED BY PERSON REPORTING INCIDENT SECTION 1 G E N E R A L Date of Time Incident of Incident Name of Employee Person involved Number Classification Minor Critical Disabling Damage Injury Division Years of Service Platoon Commander Division /Platoon Safety Representative Position Held Period in Present Position SECTION 2 Body Part Affected Injury Sustained Description of injury (e.g. laceration right hand & thumb) I N J U R Y Neck Head Eye Ear Finger Hand Arm Foot Leg Face Chest Back Abdomen Internal Multiple Respiratory System Nervous System Other Sprain Strain Laceration Fracture Burns Amputation Electric Asphyxiation Unconscious Poisoning Multiple Abrasion Shock Puncture Bruise Dislocation Inhalation Other SECTION 3 D A M A G E Description of damage to property Repair cost Total Cost: SECTION 4 I N C I D E N T A N A L Y S I S Agent(s) Hygiene Agent(s) Struck by Fall below Transport Chemical Fumes Fire Handling Machine Struck against Gas Noise Temperature Caught In Caught On Caught between Dust Radiation Other Fall on same level Other:

7 Incident / Accident Investigation Report PART B: INVESTIGATION Part A Incident Ref: Name and Designation of Investigator: Division/Platoon: SECTION 5 Human Error (Direct Cause) W H A T W A S T H E C A U S E O F T H E I N C I D E N T Personal Factors Work Conditions Job Factors (General Cause) (Direct Cause) (General Cause) Unauthorised use Unskilled Falling Debris Work conditions Unsafe Speed Inexperienced PPE Failure Unsafe conditions Safety devises not used Negative attitude Faulty equipment Using unsafe equipment Unmotivated Inappropriate conditions Unsafe use of equipment Other Poor design Unsafe procedures Inadequate lighting Unsafe position taken Unsafe floor condition Distraction Incorrect clothing PPE not used Poor ventilation Safety procedures ignored Heat or cold factor Other Other SECTION 6 P R E V E N T A T I V E A C T I O N Personal Requirements Job Requirements Complete training course Compile a written safe work procedure Follow written work procedure Undergo medical examination Transfer to another position Written warning Re-engineering /Redesign Other Assess work procedures Repair equipment / machinery Upgrade / install safety guards Modify equipment / machinery Lock out Housekeeping Remove Provide PPE SECTION 7 I N C I D E N T S U MM A R Y Summary of Incident Incident Investigator

8 SECTION 8 P R E V E N T A T I V E A C T I O N Action Plan Tasked to Date Investigator Signature Date Health & Safety Signature Date Chairperson Chief Fire Officer Signature Date SECTION 9 C O S T A N A L Y S I S Details First aid rendered = Per hour = Investigators time = Per hour = Witnesses - Wages Persons P/h/person = Totals Witnesses - Salaries Persons P/h/person = Overtime hours = Replacement for injured person = Damage costs = Labour repair costs= Persons P/h/person = Other costs = Ambulance costs = Hospital costs = Doctor costs Total Incident Costs Less: Recovered costs: Medical + Insurance = Other = Total Incident Costs

9 Appendix C - BVFES/HSE/FSMA/SOP/IRP/2005 REGULATION 6 OF GENERAL ADMIN REGULATIONS 6.1 An employer or a user, as the case may be, shall within seven days of any incident referred to in section 24 of the Act, give notice thereof to the provincial director in the form of WCL 1 or WCL 2 published in the Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993): Provided that upon future publication in the Government Gazette to the effect that where such notice was given to the Compensation Commissioner as contemplated in the Compensation for Occupational Injuries and Disease Act, 1993 (Act No. 130 of 1993), it will be deemed given to the provincial director: Provided further that where a person in consequence of such an incident dies, become unconscious, suffers the loss of a limb or part of a limb or is otherwise injured or becomes ill to such a degree that he or she is likely either to die or to suffer a permanent physical defect, such incident including any other incident as contemplated in section 24 (1) (b) and (c) of the Act, shall forthwith also be reported by the employer or user, as the case may be, to the provincial director by telephone, facsimile or similar means of communication. 6.2 When an injured person dies as a result of his injuries after notice of the incident in which he was injured has been given in terms of sub-regulation (1), the employer or user as the case may be, shall forthwith notify the provincial director of his, of her death. 6.3 The provision of sub-regulations (1) and (2) shall mutates mutandis apply in the case of incidents arising out of or in connection with the activities of persons at work, occurring to persons other than persons at work. 6.4 Any registered medical practitioner shall within 14 days of the examination or treatment of a person for a disease as contemplated in section 25 of the Act, give notice thereof to the chief inspector and the employer in the form of WCL 22 as published in the compensation for Occupational injuries and Diseases Act, 1993 (Act No. 130 of 1993). 6.5 A registered nurse or any other person may in writing give notice of any disease as contemplated in sub-regulations (4), to the employer and chief inspector

10 Appendix D- BVFES/HSE/FSMA/SOP/IRP/2005 REGULATION 8 OF GENERAL ADMIN REGULATIONS 7.1 Every employer or user shall keep at a workplace or section of a workplace, as the case may be, a record in the form of Annexure 2 per period of at least three years, which shall be open for inspection by an inspector, of all incidents which he or she is required to report in terms of section 24 of the Act and also of any other incidents which resulted in the person concerned having had to receive medical treatment other than first aid. 7.2 An employer or user shall cause every incident which may be recorded in terms of sub-regulation (1) to be investigated by himself or a person designated by him or her or by a Health & Safety Representative or a member of a Health & Safety committee within three months or within the contracted period in the case of contracted workers, and the employer or user shall cause the findings of such a person to be entered in such record. 7.3 An employer shall cause such record to be examined by the Health & Safety Committee for that workplace or section of the workplace at its next meeting and shall ensure that the chairperson of the Health & Safety Committee endorses the record to the effect that it has seen and that the necessary actions have been implemented and followed up: Provided that the employer shall also endorse the said record to such effects.

11 Appendix E - BVFES/HSE/FSMA/SOP/IRP/2005 SECTION 24: REPORT TO INSPECTOR REGARDING CERTAIN INCIDENTS 8.1 Each incident occurring at work or arising out of or in connection with the activities of persons at work, or in connection with the use of plant or machinery, in which, or in consequence of which: Any person dies, becomes unconscious, suffers the loss of a limb or part of a limb or is otherwise injured or becomes ill to such a degree that he is likely either to die or to suffer a permanent physical defect or likely to be unable for a period of at least 14 days either to work or to continue with the activity for which he was employed or is usually employed A major incident occurred, or The health or safety of any person was endangered and where: a dangerous substance was spilled; the uncontrolled release of any substance under pressure took place; machinery or any part thereof fractured or failed resulting in flying, falling or uncontrolled moving objects; or machinery ran out of control, shall, within the prescribed period and in the prescribed manner, be reported to an inspector by the employer or the user of the plant or machinery concerned, as the case may be. 8.2 In the event of an accident in which a person dies, or was injured to such an extent that he is likely to die, or suffered the loss of a limb or part of a limb, no person shall without the consent of an inspector disturb the site at which the incident occurred or remove any article or substance involved in the incident there from: provided that such action may be taken as is necessary to prevent a further incident, to remove the injured or dead, or to rescue persons from danger. 8.3 The provisions of sub-sections (1) and (2) shall not apply in respect of: A traffic accident on a public road An incident occurring in a private household, provided the householder forthwith reports the incident to the South African Police, or Any accident which is to be investigated under section 12 of the Aviation Act, 1962 (Act No. 74 of 1962). 8.4 A member of the South African Police to whom an incident was reported in terms of subsection (3) (b), shall forthwith notify an inspector thereof.