James E. Thompson, Inc. dba JTS Construction

Transcription

1 INSTRUCTIONS ACCIDENT INVESTIGATION PROGRAM: Pg. 7 Accident Investigation template to be completed in the event of an ssaccident. Pg. 8 Work-related accident instructions DISCARD THESE INSTRUCTIONS WHEN COMPLETE

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5 ACCIDENT INVESTIGATION PROGRAM ACCIDENT INVESTIGATION PROGRAM As required by Cal/OSHA, we at have implemented an Accident Investigation Program to enhance the health and safety of our employees. The main objective of an accident investigation is prevention. Our Accident Investigation Program is a means by which accidents or injuries are studied and analyzed to identify any contributing factors. Finding the causes of an accident and taking steps to control or eliminate them can prevent similar accidents from happening in the future. In order for an investigation to be a valuable tool in accident prevention, the following procedure should be followed: Identify and document all the facts of the accident using interviews, photographs and diagrams. Identify the underlying cause of the accident, such as lack of training, outdated methods, inadequate machine maintenance or lack of enforcement of safety regulations. Determine the corrective action to be taken. Monitor the effectiveness of the corrective action. Phil Engler is responsible for planning, developing and enforcing the Accident Investigation Program. This includes creating forms, implementing procedures, developing training, reviewing accident reports and trends, and periodically evaluating the effectiveness of the safety program and making changes, as necessary. To ensure compliance to our safety program, general safety rules and specific safe and healthy work practices shall be clearly understood through comprehensive training.

6 REPORTABLE INJURY OR ILLNESS T8 CCR 330(h) states, Serious injury or illness means any injury or illness occurring in a place of employment or in connection with any employment which requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation or in which an employee suffers a loss of any member of the body or suffers any serious degree of permanent disfigurement, but does not include any injury or death caused by the commission of a Penal Code violation, except the violation of Section 386 of the Penal Code, or an accident on a public street or highway. At we immediately report serious work-related injury and illness to Cal/OSHA. Work-related injuries and illnesses are categorized as follows: An injury or illness that is caused by the work environment. An injury or illness that is contributed to by the work environment. A pre-existing condition that is significantly aggravated by the work environment. Serious incidents include but are not limited to the following: 1 Incidents resulting in death. 2 Incidents resulting in loss of consciousness. 3 Incidents requiring in-patient hospitalization for a period in excess of 24 hours for other than medical observation. 4 Incidents resulting in a condition diagnosed by a physician or licensed health care professional as significant. 5 Incidents involving pesticide-related poisoning. 6 Incidents involving the loss of any body part, or resulting in a serious degree of disfigurement. is not responsible for compensation for an injury that results from an employee s voluntary participation in any off-duty recreational, social, or athletic activity that is not part of the employee s work-related assignments Note: California law states that it is a felony for any person or employee to knowingly file a fraudulent worker s compensation claim. Any person who files a false worker s compensation claim is guilty of a crime, and may be subject to felony charges which are punishable by up to five (5) years in state prison, or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by 2010 EEAP All Rights Reserved

7 imprisonment and a fine. REPORTABLE INFORMATION Company policy states that every employee must promptly report any accidents to their supervisor and participate in the investigation process. Investigations are not to place blame. Employees who report work-related injuries and illnesses are protected by law and may do so without fear of reprisal. Supervisors will immediately report all serious incidents to Cal/OSHA. Immediately means as soon as practically possible, but no longer than eight hours after the employer knows, or with diligent inquiry would have known of the death or serious injury or illness. If the employer can demonstrate that exigent circumstances exist, the time frame for the report may be made no longer than twenty-four hours after the incident. In order to facilitate accurate reporting, all pertinent information concerning any injury or illness must be documented. Our reports include: 1. Time and date of injury or illness. 2. Employer s name, address and telephone number. 3. Name and job title of the person reporting/documenting the accident. 4. Location/address where the accident occurred. 5. Name and address of the contact person at the site. 6. Name, address, date of birth, and date of hire of the injured employee. 7. What the employee was doing at the time of the injury and how the accident occurred, including a description of any equipment or tools being used. 8. How the injury occurred. Concord 1450 Enea Circle, Suite 525, Concord (925) fax (925) Fresno 2550 Mariposa Street, Ste. 4000, Fresno (559) fax (559) Foster City 1065 East Hillsdale Blvd., Ste. 110, Foster City (650) fax (650) Los Angeles 320 West 4th Street, Ste. 850, Los Angeles (213) fax (213) Fremont Civic Center Dr. Suite 310 Fremont, CA fax Modesto 4206 Technology Dr. Suite 3 Modesto, CA (209) fax (209) EEAP All Rights Reserved. 3

8 Monrovia 750 Royal Oaks Drive, Ste. 104 Monrovia (626) fax (626) Sacramento 2424 Arden Way, Ste. 165, Sacramento (916) fax (916) San Francisco 121 Spear Street, Ste. 430, San Francisco (415) fax (415) Torrance 680 Knox Street, Ste. 100, Torrance (310) fax (310) Oakland 1515 Clay Street, Ste. 1301, Oakland 9461v2 (510) fax (510) San Bernardino 464 W. 4th St., Ste. 332, San Bernardino (909) fax (909) Santa Ana 2000 E. McFadden Ave., Ste 122, Santa Ana (714) fax (714) Van Nuys 6150 Van Nuys Boulevard, Ste. 405, Van Nuys (818) fax (818) Redding (field office) 381 Hemsted Drive, Redding (530) fax (530) San Diego 7575 Metropolitan Drive, Ste. 207, San Diego (619) fax (619) Santa Rosa 1221 Farmers Lane, Ste. 300, Santa Rosa (707) fax (707) West Covina 1906 West Garvey Ave So, Ste. 200, West Covina (626) fax (626) Torrance 680 Knox Street, Ste. 100, Torrance (310) fax (310) Process Safety Management Unit Concord 1450 Enea Circle, Ste. 550, Concord (925) fax (925) Sacramento 2211 Park Towne Circle, Ste. 2, Sacramento (916) fax (916) Mining and Tunneling Unit Van Nuys 6150 Van Nuys Boulevard, Ste. 310, Van Nuys (818) fax (818) San Bernardino 464 West 4th Street, Ste. 354, San Bernardino (909) fax (909) Santa Ana 2000 East McFadden Avenue, Suite 111, Santa Ana (714) fax (714) High Hazard Compliance Unit Oakland 1515 Clay Street, Suite 1303, Oakland (510) fax (510) EEAP All Rights Reserved

9 9. Description of the injury, the part of the body that was affected, and the severity of the conditions. 10. What object or substance directly injured the employee. 11. Location where injured employee was taken for medical treatment. 12. The required corrective actions and the supervisor responsible for making the corrections. 13. List and identity of any law enforcement personnel present at the site of the accident. 14. If attended by a physician, the name and address of the physician. 15. If hospitalized, the name and address of the hospital. 16. If the employee died, when did the death occur? When reporting an accident, use the following list to locate the phone number of the nearest Cal/OHSA district office: Investigative Procedures The actual procedures used in an investigation depend on the nature and results of the accident. The investigation should begin as soon as possible after the incident so as to observe the conditions as they were at the time and while information is fresh in the minds of the witnesses. The process should include the following elements: 1. Report the accident occurrence to a designated person with the company. 2. Provide first aid and medical care to the injured person(s). 3. Investigate the accident. 4. Identify the causes. 5. Report the findings. 6. Develop and implement a plan for corrective action. 7. Evaluate the effectiveness of the corrective action. 8. Make changes for continuous improvement. A company official shall appoint an individual to be in charge of the investigation, and team members to assist as needed. When conducting an investigation, gather evidence from as many sources as possible, and keep the documentation and notes together in a bound notebook. The investigator assigned to the case will: 1. Present a preliminary briefing to the investigating team, including: a. A description of the accident, with damage estimates. b. Normal operating procedures. c. Maps (local and general). d. Location of the accident site. e. List of witnesses. f. Events that preceded the accident. 2. Visit the accident site to get updated information. 3. Inspect the accident site. a. Secure the area. Do not disturb the scene unless a hazard exists. b. Take photographs and/or make sketches of the accident scene. Label each carefully and keep accurate records of all data, including maps EEAP All Rights Reserved. 5

10 4. Conduct interviews. a. Explain the purpose of the investigation (accident prevention) to put each witness at ease. b. Interview each victim and witness. c. Interview those who arrived at the site shortly after the accident. d. Keep accurate records of each interview, documenting the exact words used by the witnesses to describe their observations. A tape recorder may be used to record the interview, but only with the permission and consent of the witness who is making the statement. e. Have each witness sign their statement, and then provide them with a copy. 5. Determine: a. Pre-accident conditions and abnormalities. b. When the abnormality was first noticed. c. The accident sequence. d. Post-accident conditions. 6. Analyze data to determine a likely sequence of probable causes. 7. Conduct a post-investigation briefing. 8. Prepare a summary report, including the recommended actions to prevent a recurrence. RECORDKEEPING Cal/OSHA not only requires reporting about safety and injuries in the workplace, but recordkeeping as well. A document called the Cal/OSHA Form 300 is an annual summary of work-related deaths and/or injuries and illnesses that required more than basic first aid, and it is required to be posted in the workplace. Store safety and training records for 5 years EEAP All Rights Reserved

11 300 E Planz Road ACCIDENT INVESTIGATION Date of injury/illness: Time of day: : a.m./p.m. (circle one) Name and job title of person taking report: Is this a serious, Cal/Osha reportable accident? Yes No If yes, the accident was reported to Cal/OSHA on at : am/pm. (circle one) Accident reported to Cal/OSHA by: Location where the incident occurred: Name and address of the contact at the site: Name(s) of witnesses: Injured employee s name: Address: Phone: Description of injury, body part affected, severity of condition: What was the employee doing when injured? How did the accident occur? EEAP All Rights Reserved. 7

13 Required Elements for the Cal/OSHA 300 Equivalent Form I. California employers who are required to record work-related injuries and illnesses on the Cal/OSHA Form 300 may use an equivalent form that includes all of the following instructions and information. Log of Work-Related Injuries and Illnesses Instruction: You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 8 CCR through Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you re not sure whether a case is recordable, contact the nearest office of the Division of Occupational Safety and Health for assistance. Establishment Name & Address Identify the Person (A)-(C) A. Case Number B. Employee s Name C. Job Title Describe the Case (D)-(F): D. Date of Injury or illness E. Where the event occurred F. Describe the injury or illness, part(s) of the body affected, and object/substance that directly injured or made the person ill Classify the Case (G)-(M) Using these four categories (G)-(J), indicate only the most serious result for each case: G. Death H. Days away from work I. Remained at work as Other recordable cases J. Remained at work with Job transfer or restriction Enter the number of days the injured or ill worker was: K. Number of days the injured or ill worker was On job transfer or restrictions L. Number of days the injured or ill worker was Away from work EEAP All Rights Reserved. 9

14 M. Indicate an injury or, one type of illness: (1) Injury column (2) Skin disorder column (3) Respiratory condition column (4) Poisoning column (5) All other illnesses column Page Totals {for columns (G)-(M)} Instruction: Transfer these totals to the Summary page (Cal/OSHA Form 300A) before you post it. Instructions for privacy concerns: ATTENTION: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. Note: Privacy Concern Cases: employers using forms equivalent to the Cal/OSHA 300 are required to follow the privacy concern disclosure restrictions specified in Section (b)(6)-(10). Note: Additional Criteria. Beginning January 1, 2002, employers are required to record the following as specific injury and illness conditions. These are: 1. Injury from a needle or other sharp object that is contaminated with blood or OPIM (Reference: Section ) 2. Cases of medical removal under the requirements of a Cal/OSHA standard. (Reference: Section ) 3. Tuberculosis infection as evidenced by a positive skin test or diagnosis by a physician. (Reference: Section ) NOTE: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code EEAP All Rights Reserved

15 Required Elements for the Cal/OSHA Form 300A, Annual Summary of Work-Related Injuries and Illnesses Equivalent Form A. Employers who are required to complete the Cal/OSHA Form 300A may use an equivalent form that provides all of the following information: 1. The number of cases: (G) The total number of deaths (H) The total number of cases with days away from work (I) The total number of cases with job transfers or restriction (J) The total number of other recordable cases 2. The number of days: (K) The total number of days of job transfer or restriction (L) The total number of days away from work (M) Injury and Illness Types, the total numbers of: 1. Injuries 2. Skin disorders 3. Respiratory conditions 4. Poisonings 5. All other illnesses 3. Posting requirement statement: Post this Annual Summary from February 1 to April 30 of the year following the year covered by the form. 4. Establishment information: The establishment name Street address City, State, Zip Industry description The Standard Industry Classification Code, if known. 5. Employment information The annual average number of employees. The total hours worked by all employees last year. (For assistance in calculating the annual average number of employees, and total hours worked, refer to Appendix G.) 6. Sign Here: Admonition: Knowingly falsifying this statement may result in a fine EEAP All Rights Reserved. 11

16 Certification statement: I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete. Space for the signature of the company executive, and title. Phone number of signatory. Date of the certification. NOTE: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code EEAP All Rights Reserved

17 Required Elements for the Cal/OSHA 301 Injury and Illness Incident Report Equivalent Form I. An employer that is required to fill out a Cal/OSHA Form 301 may use an equivalent form that provides the following items of information: A. Information about the employee: 1. Full name 2. Home street address, city, state and Zip code 3. Date of birth 4. Date hired 5. Employee gender B. Information about the physician or other health care professional: 6. Name of the physician or other health care professional who treated the employee 7. Name and complete address of the facility where the employee received treatment (if applicable) 8. If the employee was treated in an emergency room (yes or no) 9. If the employee was hospitalized overnight as an in-patient (yes or no) C. Information about the case: 10. The case number matching the Cal/OSHA Log 300 (or equivalent) entry 11. The date of the injury or illness 12. Time of employee began work AM/PM 13. Time of the event AM/PM; or indication that the time cannot be determined 14. Description of what the employee was doing just before the incident occurred 15. Description of what happened; how the injury/illness occurred 16. The specific injury/illness, part(s) of the body affected, and medical diagnosis if available 17. Identify the object or substance that directly harmed the employee 18. If the employee died, the date of death D. The name of the person the form was completed by E. The title of the person who completed the form F. The phone number of the person who completed the form G. Privacy concern instruction: ATTENTION: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. Reference: Section (b)(6)-(10) EEAP All Rights Reserved. 13

18 H. The instruction Within 7 days of receiving information that a recordable work-related injury or illness has occurred, you must fill out this form or the Cal/OSHA Form 301. II. Note: When a work-connected fatality or serious injury occurs, every employer is required to report the incident immediately (within 8 hours) by telephone or in person to the nearest District Office of the Division of Occupational Safety and Health. Reference: General Industry Safety Orders Section 342 Reporting Work-Connected Fatalities and Serious Injuries. NOTE: Authority cited: Section 6410, Labor Code. Reference: Section 6410, Labor Code EEAP All Rights Reserved