GUIDANCE ON COMPLETING ACCIDENT REPORT FORMS AF1, AF2 AND AF3

Transcription

1 GUIDANCE ON COMPLETING ACCIDENT REPORT FORMS AF1, AF2 AND AF3 Purpose of AF1 The purpose of the AF1 is to obtain a statement from the Provider giving its account of the accident and details of the accident and injury in a format suitable for scanning onto the national database. Action Required. The AF1 must be used to report any Relevant Accident. To obtain a full picture of the accident, the completed AF1 should be supported by completed forms AF2 and AF3, where appropriate. PAGE 1 PAGE 2 SDS Area Insert the appropriate SDS area, i.e where the trainee lives. Accident Number This will be given to you by the SDS safety staff when you report the accident. Non employed participant or employed trainee name Insert full name Rec d in GO Do not enter any details in this box. Details of Injured Person Title All other boxes in this Section are self-explanatory. Brief Account of Accident Give a brief summary of what happened and the injuries sustained. Programme injured person was on at the time of accident Insert appropriate number in the box. Programme start date Insert the date when the non employed participant or employed trainee first started with the main Provider. Placement start date Insert the date when the non employed participant or employed trainee first started at the Placement where the injury happened. Main provider Insert the name, address and postcode of the Provider.

2 Placement provider Insert the name, address and postcode of the Work Placement, if applicable. Employment Status Classification of accident Date of accident Insert the date that the accident occurred. Time of accident Insert the time the accident occurred using 24 hour clock. Did the Accident Happen During Normal Work/Training Activity These are accidents in all work locations where the Provider, Work Placement, or their supervisors have direct control over the non employed participant or employed trainee (including horseplay, etc.) Off-the-Job Training These are accidents in training centres, training workshops, information technology centres, etc. Meal Break Accidents in a scheduled meal break at a workplace (including horseplay, etc.) Recreational Accidents This includes all accidents on residential training (emphasis on outdoor pursuits) College These are accidents that occur on college premises. Other Injury not directly related to an accident, e.g. self-inflicted injury or prior medical condition PAGE 3 Severity and type of accident Fatality Do not complete any other section. Go to the details of the person completing the report.

3 Specified Injury Details of the injury should be specified in the brief account of accident section. Over 7-Day Go to the box for minor fracture, cut, bruise, strain/sprain, burn/scald and click in the appropriate box to insert a tick. Has the accident been reported to HSE? About the kind of accident Move the curser to the appropriate box and tick to insert a tick. Contact with Moving Machinery or Metal being Machined Contact with cutting edges or rotating shafts of machinery, or material being machined. This includes running nips and injuries due to lack of guarding. Struck by Moving Vehicle These are injuries to pedestrians in work areas, on public roads and on private land. Injured While Handling, Lifting or Carrying Pulling; pushing; lifting; carrying; throwing; free bodily motion not involving objects (e.g. pulled muscle while running) Fall From Height Falls from animals; temporary or permanent structures e.g. ladders, stairs, through roofs, ceilings, and openings in floors; into excavations, pits, manholes and trenches. Struck by Moving, Falling or Flying Objects This is the motion of an object (not vehicle or animal). e.g. cut finger with knife; hit thumb with hammer; falling objects; struck in eye by flying object, dust etc. Struck Against Something Fixed or Stationary Stepping on or striking against stationary and fixed objects where the motion is primarily that of the person rather than the object. Slip Trip or Fall on Same Level Where a person falls to the floor, ground, etc. on the same level. Trapped By Something Collapsing or Overturning This is being caught or trapped in, or between collapsing materials such as slides of earth, collapsing buildings or scaffolds.

4 Exposure to Fire This is exposure to or contact with fire. Excludes burns from touching hot metal, and scalds. Exposure To, Or Contact with Harmful Substances This is inhalation; ingestion; absorption; chemical burns; inflammation and arc-eye. Also includes physical contact with very hot or very cold substances. Contact with Electricity or Electrical Discharge Exposure to/contact with electricity. Injured By an Animal This means injury as a direct result of contact with animals. It excludes falling off a horse or accidents where the animal is struck by a vehicle and the impact results in personal injury. Assault Physical and mental (e.g. intimidation with firearm) Horseplay Larking around Road Traffic Accidents Injuries caused by moving vehicles on public roads. This includes injuries while trainees are working on, or at the side of a public road (including loading and unloading vehicles). Part most seriously injured: Identify if left or right side, move the curser to the appropriate box and click in the box - a tick will be inserted. Identify which part of the body, move the curser to the appropriate box and click in the box - a tick will be inserted. PAGE 4 Details of accident Move the curser to the appropriate boxes and click in the box a tick will be inserted. If the answer no is given to any points, complete the specific box below. Details of person completing report Complete all sections and return the form to the relevant SDS Health and Safety Officer: Jim Lindsay 5 Carinthia Way, Clydebank G81 2UA or Tom Hunter Cairngorm House Almondvale Boulevard Livingston EH54 6QN

5 Causation Factors Please do not enter any details in this box. A competent person within SDS Health & Safety will complete causation factors for non-employed trainees. GUIDANCE ON COMPLETING FORM AF2 TO BE COMPLETED BY NCS HEALTH & SAFETY STAFF ONLY Purpose of AF2 The AF2 must be completed for all non-employed participant accidents only, reportable under the contract with The Skills Development Scotland Co. Ltd. To obtain a full picture of the accident, the completed AF2 should be associated with the completed forms AF1 and AF3. Action Required The Officer should structure the accident investigation to ensure all facts are collected, checked and analysed. (The level of investigation can only be determined by SDS Health & Safety staff). Investigate the accident by telephone or correspondence only if nothing can be gained by visiting the scene. The narrative report must be factually correct, without opinions and be complete in itself. It should be typed where possible. The form sets out recommended headings, but other information relevant to the accident investigation may be included. 1. Participant name 2. Date of investigation Please explain any significant delay by SDS Safety Staff or the Training Provider in the investigation or reporting of the accident. 3. Placement Where relevant give the name, address and business of the work placement provider where the accident occurred. 4. Persons interviewed Always try to include the injured/diseased person s immediate supervisor, other relevant members of supervision/management, Training Provider staff and appropriate witnesses. 5. Circumstances Provide a narrative of what happened. Where relevant describe machinery, plant or equipment, guarding, fencing and PPE. State whether the participant had received appropriate information, instruction, training and supervision to perform the task. State whether appropriate risk assessment/controls were in evidence. 6. Training Provider Control Where the incident occurred at a work placement, SDS Safety Staff should confirm there was a satisfactory contract between the Training Provider and the placement provider. Had adequate initial assessment inspection and subsequent monitoring taken place?

6 7. Documentation Completed Please confirm, wherever possible, if an entry was made in the Accident Book, if form F2508 has been completed and that Employers Liability (Compulsory Insurance) is in place. 8. Preventative Measures State whether the accident has highlighted any shortfalls in the Training Provider s controls, which might have helped prevent the accident. What action has been required by SDS and/or by Training Provider; to prevent a recurrence? 9. Follow-up Action State who in the SDS is responsible for ensuring that the appropriate action takes place and how and when will this be achieved. AF3 Participant Statement Purpose of AF3 The purpose of the form AF3 is to confirm an injury to a non-employed participant. The Job Centre Plus administers Industrial Injuries Scheme, which pays a disability benefit to non-employed participant to ensure that they are not disadvantaged as a result of an injury. The DWP pays Disablement Benefit to employed earners who are injured as a result of an accident. Evidence is required by the Job Centre Plus to allow an adjudication team to make a decision on whether or not an injury has been caused by an industrial accident. Action Required The AF3 is forwarded to the trainee by the Training Provider. The non-employed participant completes the AF3 which includes a statement that details the events of the accident and the injuries sustained. This is then returned to the nominated Health & Safety Officer. Training Providers should inform non-employed participant to contact local Job Centre office if they want advice on Industrial Injuries Scheme. ov.uk%2fgovernment%2fuploads%2fsystem%2fuploads%2fattachment_data%2ffile%2f %2fbi100a_print.pdf