Document 5b0668eENOr69mqR2v3X9LnV5
PROCEDURE BULLETIN-Texas city plan P-011
INJURY, ILLSffiSsTAND NEAR-MISS , INVESTIGATION AND REPORTING '.pP1-fl:
PURPOSE
a
' i.
It is the purpose of this bulletin to define the various clas sifications of injury or illness severities, to describe the procedure for reporting an injury or illness, and to provide for the investigation of those incidents resulting in injury or illness. Near-miss accident and incident investigations ** * - and reporting are also included.
II. POLICY
III.
' **
V 41
. ? >
* -i*
Any death, injury (no matter how small)> or illness suffered
by an employee which arises out of and in the course of his
employment, must be reported immediately for treatment and in-,
vestigation.
'
scope ~< '/
*
, *,
This procedure applies to all employees at the Texas City loca
tion. ' A similar procedure applies to injuries occurring to
contractor employees (see P-0113). The classifications of
injury or illness severity are as follows:
.,
A. First-Aid Cases '
r
V
5/
-
' ..'.:14s;
v These cases;? involve any injury which requires first aid: or
medical attention of any. kind but is of, such minor natures:
that it does not meet the criteria of- other: injury classic
fications.
-
,> ,
>
-* '451-. B.
Kl , .
Recordable Injury or Illness
-
Any injury or illness suffered by an employee which arises
out of and- in the course.of hisemployment/Jwhile working,5,|^,|:i|.Vl;-;|:;
on or off tfie Company''premises'/'''is; recordable if it`results`?*;f5Sl:'
in death, loss of consciousness, reduction of work or motion,
:~
diagnosed occupational illness, transfer to another job, or
requires medical treatment other than first aid.
Medical Treatment
Medical treatment is that treatment administered by a physi
cian, nurse, or other professional medical personnel under
.the standing orders of a physician,
.% ... .
First Aid
1. First aid is limited to one-time treatment and any follow up visits for the purpose of observation. (Minor scratches, cuts, burns, splinters, etc.)
SC 005431
ORIGINAL ISSUE: 7/11/59 REVISED: 10/30/80
page-L.ofJL
LA/V/006647
PROCEDURE BULLETIN!^ ctv wsAr i 10-^2
: injury#; .iiaaiEssfS^i
:-MiSS INVESTIGATION AND REPORTINGI
**.
r, rT,-r
.f-up^yisits., may., include ...the changing of dressing,
'V V-; or bandage, and additional cleaning and application of
I9tbe*" professional Iie'd|ciE',pirScilcfeiS :
i-tfi `3M
.. C. Y>
required distinguishes between medical treatment and
first aid.
/.
ViS^;
-\ri-;:
'V- \
i fV"A
Lost Workday Cases
"V: ''-
r>:I-
t -
-ft*
0
:'
'#?
absent from the job for entire shifts he.'^'-.^V"
would normally be1 scheduled to work This is called.
'^ '
thereafter
r/ Examples' of restricted \i'4* -
bSamejob,but- not all duties.
.*t
lull shift.
: . d.~ Termination or permanent transfer.
- -- ^ *
N
3
uoo>
BH WmB
If * ' ' ''
>: . !.- > , : .v ':' jpjgpg#
Sometimes the restriction depends upon the nature of *
the\work performed by an employee.
llfSl
Injury Determination `
-
Determination as to whether or not the reported injury
O (0
should be considered a work injury is based on the evidence developed in an investigation.
Preponderance of Evidence -
<'.'
-'-V
Evidence to be considered:
^
1. Facts about employee's work activities and working environment.
^
2. Statements of the injured employee, fellow workers, witnesses, and supervisors.
)
ORIGINAL ISSUE: 7/11/59
REVISED: io/30/so
PAGEJL0F.iL LAM006642
/
/
PROCEDURE BULLETINSTEXAS CITY PLAMT P-0112
' "' TU
'____________
UiaE;4,
* AND NEAR-MISS INVES^""`""~
SiSHM
3. Medical reports.
-* '
* ..
V.',
.
1* -J
4. Facts about employee*s work for others
the-job activities, injuries and illnesses.
the site, interviewing the injured, and investigation of
m circumstances leading to the" illness or`injury. Loss
Prevention and Safety will assist as appropriate.
^ /-*' ' ' ,5
: .J
Exceptions will be judged in the usual way as in the past
by recommendations from Loss Prevention and Safety and the
*ssk
mm
:;fe: Plant Manager making, the final decision.
J ':< A ''
; ~7<` }
rv" '
\ 1 " . -!*' ^ ' '.I'b'i
/\ v; Wm
IV. RESPONSIBILITY AND PROCEDURE ................................4:".>:il >!?
. . * .*......3....;*y mmm
The injured (unless incapacitated and additional help is re j
m
quired) is responsible for reporting his/her injury to the , dispensary for treatment. The supervisor of the injured is
m
iSi
GK
mmmresponsible for the investigation of the events preceding the
injury and for establishing immediate corrective.measures-sA,.,:..'..
The general superintendent of the department in which injury. ; (
occurs is responsible for the investigation of the incident;
review, approval^ and distribution of the reports; and for the
, u *: & recoraing, preparation ana aistrinution or conpiled from this information.
spll f
_Fh*oAir ft.nh. e pnnuvrp^rotseea ro* 4_fs reportin g the occurrence of ' allT injuries ' and
subsequent investigation, the Accident a.nd I_n_ _ju__r_y___R__e__p_o__r_t__f_o_r_m____is used." This report"is initiated by the Plant Nurse (or'Night ' `
Supervisor) on any injury requiring treatment.; She fills out pages one (1) and four (4) of the form. > The .injured employee,. after treatment, will take the form to his immediate supervisor. Injuries are the direct concern of the supervision of the area in which the incident occurs, and the action needed to correct the cause must be initiated by that supervision. In addition, the report serves as the injured's claim for insurance benefits.
5 v*;
A. First-Aid Cases and Recordable - Medical Treatment Only ..
The investigation of the accident should be held by the im mediate supervisor at the time he receives the notice of the injury preferably, but no later than the next working day... The report (pages 2 and 3) is completed by the supervisor and the form mailed to the Loss Prevention & Safety Depart ment on completion of the investigation.
y
sc 005433
ORIGINAL ISSUE* 7/11/59 REVISED: 10/30/80
RAGE iL. OF. 8
LAIVI006643
PROCEDURE- BULLETINi-TEXAS CITY PLANT P-0112
'~nr? INJURY/ ILLNESS/ AND NEAR-MISS INVESTIGATION AND REPORTING*
V
.:*
- '' O
An accident involving a slight injury' may reveal' as many, .: +'.'Sy.V' constructive conclusions as the investigation of am accident
involving a fatality.^ Whether or not the result is a scraped shin or a fractured skull; is often a matter of cheUtiCeSr Many f . Y:-* ^^sligh^i^tiies could^just as'easily, have been fatalities?: That/s^whiy,5 evejTff accident must be investigated by, a visit, to,..
i
Recordable Injuries'- Lost Workday Cases (both Restricted* X t)uty and Days Away from WorK)^,M^ Hi,
* AlV,
, ` i IK1'. yth
will
.. general superintendent responsible, for the employee who.
sus^s^i'Ja^recqrdable(. injury, that. fits, these, categories^
^ . JTI^Je^
willt^eport verbally'ItoJ- ,the Pi
Xresultsji>f `the 'injury, investigation
...1 . withT.ri 4*1^" the CSimuApweiri innJteAnn^dAewniit of TPIawemrsmomnmnaeI l and theikM<9 4>t*ia TLMoms* ns: ; PrevAen4n>t4ioAnn.-
yW
I*
M&t.A'fcarefia^C^^lSttt / logiriaS^malys'is of* the; eventX^o
<-J**vbe madej'a part pf .ie\.inju!ryi^
pp'ssfttfS
*???: -7 impacts
or.,depwtanimX^ .'S* p.iar^wide laasisl^^
.De|ndiii^t|h fthe" nature ' arid' extent^ Y 1*- irivestigatioXafr"^ ?<?*' '1
*V: X- ma?la?B5/-a,1i^ailaiyt^-c%"sPcialist' may^lX employed.,,Ct A Jriritten. ,.;7 reppt;af4>.Jb-. iriciderit, will^be'; published.'within 5" working;' >-*' ,,
5; daysXferTthe incident 'by/thXpersorif''(dr`'.'rieeua chairman)" assigned
4; by,the. General Superintendent.;!; The investigating person. or. team i
will; be;;fixedXt,, the.''time^c^evlew1&|:irit>llfcases!!#l^^
copies of the report will be sent to members of the Plant'-''^^;'1;::
Manager's Safety Board and the Plant Manager's expanded staff.
TOUCH 85 may be used to notify plant personnel of. the incident.
C. Near-Miss Accidents and Injuries
Near-misses include accidents and incidents which*iri the31 9* opinion of the injured person's department supervision or Loss Prevention and Safety Superintendent's opinioncould have resulted in major injury, severe equipment damage or a catastrophic occurrence with but a slight reasonable'change in immediate circumstances. These incidents must be investi gated and reported according to the procedure outlined in Sections V and VI of this report.
SC 005434
)
ORIGINAL ISSUE: 7/11/59 REVISED: 10/30/80
PAGE jL. OFJL
LAM006644
PROCEDURE BULLETIN-ra.* Clrr ^
injury; illness, AND near-miss investigation and reporting
ACCIDENT AND INJURY INVESTIGATION AND REPORTING
rV '
" V-. - ::
,,
- . >. W^
>'%& . vi,
-V , ..
\'P "'V-; //'/i/'
'
Since every accident and injury represents a deviation from a
1
planned result a careful analysis is required so that appropriate
corrective actions can be taken to prevent a recurrence.
` '
_
' '
...........'
Managerial Analytics or Analytic Trouble Shooting (ATS) processes,;
should beTused/to^ihsuteTdete^^ to develop'''appropriat:e!ractiohs;;':f^and^'to;diefine'how 'the'*actionil;':;:'-''
will be carried out. * In complex investigations the services of.
a Managerial Analytics Specialist should be employed.
A,-`
- / -rv
ill
Investigation Procedure - Finding Cause(s) of Accidents
Every accident is the result of one or more causes.c Tte"--*****
purpose of the investigation is| to determine the unplanned
combination of actions and ageritfs that determined the
cause(s)rbf the accident.
,,
. '.
`
The steps in finding the cause(s) of accidents should follow
the Deviation Analysis of Managerial Analytics (MA) or
Problem Solving,Procedure of Analytic Trouble Shooting (ATS).
1. State the deviation for which the cause is unknown.
A
v* 1
.2 Get the facts; necessary to fully specify the deviation.L % i
Determine what happened as well as what might have been1 '-H/i *
expected-'to; happenhut;'didf-'lxot. Specify all that is \
known* about the event including:
, - i'r . \
a. All available information about the injured person:
(1) What he was supposed to be doing. .
(2) What he was actually doing at the time ofthe
""accident"'and how he'., was - doing 'it'.',
(3) His training. :' ' '
''
(4) His past record.
=
b. Results of a visit to the site for an examination of the following:
" (1) Tools ' " / *'
SC
005435
(2) Machinery
""
(3) Protective equipments
(4) Other physical conditions as they existed at
the time and place of the accident.
Use the attached form or other appropriate specification sheet to record the available data.
ORIGINAL ISSUE: 7/11/59
REVISED: 10/30/80
PAGE J-OFJ
LAM006645
PROCEDyRI^^^yLLETINwjg^^jgij^^jj^j^i^p^oiia
-jess F" INJURY, ILLNESS, AND NEAR-MISS INVESTIGATION ...AND REPORTING.flp!;!'^PF'F;;S%^'.
mmm
3. Look for, identify, and record the unique characteristics or differences between the items that were involved and"
Notes'!, ln^tepaL2ifc!3^xd 4F special"effort, shoui^^^|'J '
made to try to find out all the contributing factors..', ::*;F
Facts*! as, ,1&ey^aro- fonand;.,should
acknowledgedF^,,-
face..to,. face^f,.Ah;'ihvestigatibn,/sh6tiid^hot, be looked'i
as; a"hecessaiy\revil^;..but^.,ra1*er>B>ih;jits^trueulight,^^hichi^;i|;
isv't^e'opjpbiimity;,t6' brixwTal&ttfe.bettei^conferol^ofS^sif
acts'^or*o^^
tiF',*/s* *. v
15
ng for grantedsm Every, alleged fact wnMtms^^
knows Just, exactly, what, happened~which, means, who,idid.J^|;;$'-r or did not do something and why and^ask.^eiinj-ured'. person"""'
... ... .
controlling <-
`'
the observed deviation effect! (accident/or injury) F In , doing! this* focus" oh the;' uniquoicharacferistics or ,differ-^t;
F*T\ences^ahdT chamge^events 'to'..'ta^ to?tdentify' action/agent
combinations which might have caused the accident or
,3 *
injury. ^ F*;F *;
'i / ^
F-*l
.i
6 Test possible causes to determine which one of the possi-
bilitles developed in step 5 above fits all of the facts
developed on the specification sheet.
v.
to 7. Set priority on probable causes. Which probable cause
CO V
needs to be checked first? if uncorrected which combina
ou> tion of agents/actions might cause additional accidental
o loss or personal injury?
8. Verification of cause requires a plan to verify the cause
including:
O OT a. What will be done.
b. Who will do it. c. When it will be done.
j
ORIGINAL ISSUE: 7/11/59
REVISED: 10/30/80
PAGE JLOF.JL LAM006646
PROCEDURE BULLETIN--texas city plakt p~112
INJURY,^ILLNESS, AND NEAR-MISS INVESTIGATION AND REPORTING
Extra care may be necessary during the verification or investigation to avoid remaining hazards or new hazards created by the incident.
9. Summarize investigation by re-stating the deviation and the most probable cause(s) and the reasons for rejecting other likely causes. Recognize circumstances that may have increased or reduced the extent or seriousness of the event.- Classify cause (s) as unsafe action, condi tion or both.
10. Recommend appropriate actions by making certain that the action/agent combination no longer exist or can re-occur. Be sure to consider the circumstances or conditions sur-
' rounding the event when developing action plans to pre vent future events or to reduce their seriousness if they should occur. The MA processes of Action Planning or Potential Deviation Analysis are useful in developing appropriate plans in complex situations. If assistance is needed, contact a MA Specialist.
B. Reporting Procedure ' -
1. First-aid and Recordable-Medical treatment only cases will be reported on the First-Aid form provided by the dispensary as indicated in Section IV.A. of this bulletin.
2. Recordable Injuries - Lost Workday Cases and Days Away 5 ,, from Work Cases will require a concise written report summarizing the results of the investigation and finding of most probable causes.
a. The person responsible for the investigation will prepare a rough draft according to the attached format.
005437
b. The investigation report will be approved by the General Superintendent involved and the Plant Manager and will be distributed to all plant supervision.
c. In addition to the abbreviated report distributed it is expected that line supervision will be made familiar with the details of the accident through the line organization.
d. A report of status of recommendations will be issued within 5 working days by the supervisor involved to the concerned Superintendent and the Loss Prevention and Safety Superintendent. Supplementary monthly reports will be made until all recommendations have been answered.
ORIGINAL ISSUE: 7/11/59
REVISED: 5/4/82
PAGE -Z--OF-JL
LAM006647
PKOC^EDU^Ej|i_BULLETjN_--Tgx^s=g]TY_p^AM7ir_j^^?
INJURY, ILLNESS, AND NEAR-MISS INVESTIGATION AND REPORTING
O
A
IV.
3. Distribution of Reports - Copies of all Incident or Injury Reports that are assigned to a number by LP&S will be sent to the MCI Plant Manager's Task Force members and Safety Superintendents listed in Appendix III.:-
FORMAT
- -r. X
c
The format to be used in the preparation of the accident
investigation is attached as Appendix P-0112-11.
V'^~
S' ^is: 1,!~"-r -v.v r
*,_nr. /*
x cri
: ^"A*.1' a ^v"**1^
r sir.ty'
Revised byry
* -4 - -
T-
*0, i?
.'/jy;X;- J . A. Glass
' ftikv:. r-j-.: rtyi:? sr.. '' -> ; :v;ri'V'jv'srj'i?'-
'
; ; '. \
;;
\ li r. ivlys^z
1 r}i
r.
vi'>*><-.:4s-
it/-:
. v'--A~rA-y v I/',:
*.y>y r;'y:\
o
n?, v
.
-:i,>
.'' ,-r
; -/>; ;/' ' v <"; .y ' ' / ;`^-U-;y
:_ y s^' A . y^` S . '
'; -L'y, y->VS':y ,-i'-
: - '-\-r'-'.'-si yf
; ' : :>
SC 005438
ORIGINAL ISSUED 7/11/59
REVISED: 5/4/82
J
PAGE -JLOF-JL LAM006648
APPENDIX III
PROCEDURE BULLETIN-tfXAS CITY PLANT P-0112
INJURY, ILLNESS, AND NEAR-MISS INVESTIGATION AND REPORTING
REPORTING PROCEDURE
Distribution of Reports - Copies of all Incident or Injury Reports that are assigned a number by LP&S will be sent to the following MCI Plant Manager's Task Force members and Safety Superintendents:
Plant Managers and Guest Superintendents
D. W. Brubaker (Pensacola) D. V. Haines (Soda Springs) J. W. Molloy (W. G. Krummrich) G. F. Knollmeyer (Queeny) J. L. Rasmussen (Decatur) Needham Coppedge (Columbia) Baxter Tilford (Avon) G. E. Davenport (Chocolate Bayou)
1690 1850 1740
1760 1260 1220 1090 1200
rf Safety Superintendents
Ray Wilson (Pensacola) Tom D. Filiput (J. F. Queeny) Ralph Brown (Soda Springs) Paul Heisler (Krummrich) \ Maurice M. Whitlow (Columbia) Mayben Yount (Decatur) John Ussery (Chocolate Bayou)
1690 1760 1850 1740 1220 1260
1200
Safety & Property Protection
Tom W. Lawrence (St. Louis)
. F2WA
Copies of all reports on Lost Work Day cases should be sent to the above listed plus:
E. N. Brasfield (St. Louis) J. R. Thurrott (St. Louis)
G4NE G4NH
SC 005439
ORIGINAL ISSUE-* 7/11/59 REVISED: 5/4/82
LAIVI006649 PAGE _L0F_i_
^i
(Use of this form is optional) .
P-0112 APPENDIX I
; ' ACCIDENT OR INCIDENT- INVESTIGATION SPECIFICATION SHEET
l / Date: __ _________________
Prepared by:
___________________
column- l (
;.
COLUMN 2
QUESTIONS
Was involved in.the incident Might be expected to be
^ f' 'W-V 1 ,
. BUT WAS NOT INVOLVED
SP
WHAT
;
f H>>'-
- WAS BEING DONE? !
- ,V '
'4^ r
,sv
- IS DEVIATION? - IS DEFECT? .. < ;-`V
**?& "4 , S-'*'" M V*
"
* ,J
; '1 -*
* -y >/:$
- IS OBJECT J >
, OF DEFECT? i
- *"
* * ' r *
"v#- r-lfJvz/ . J ** *
^
* * f"***
*
WHERE,. '
r ON PUNT? ' V
l>y. *
/ Js% ` * xf' ;,fr
- ON EQUIPMENT?
- ON PERSON?
- IN PROCESS?
V*
,
i V*; -`
i- V ~<:4f t\ '
, sr:.
cfLfe:
-
-> HAPPENED? . - EVENTS BEFORE? ***** 1
- - OTHER EVENTS?, ;
. - EVENTS AFTER?
- - TRAINED ON THIS JOB? -
|
WHO
- IS AFFECTED? - WITNESSED? - TRAINED INJURED? - IS SUPERVISOR?
EXTENT OF DEVIATION
- EFFECT?
- INJURY?
- PERSONAL PROTECTIV EQUIPMENT USED?
-" ^5 '
,V
:1?/> *
` ^1 '
Vi " |%/-; ,1** / - .r-
' * "f i
"* _ * * *
"t** ** C* % ^
_ i't '
SC 005440
LAWI006650
ORIGINAL ISSUE: 7/: 1/59 1
REVISED: 10/30/80
PAGE: 1 OF 2
(Use of this form is optional) /--I
. P-0112
- > accident or incident investigation .specification sheet
. .. -'t-- -<**
, ' ;.
;
A?,i j ; *
&s$PRSNNi
M0mm, mm
. IS DEVIATION?
tt ' COLUMN 3
Unique characteristics of. THE INVOLVED DIMENSION
s\%*i *4p*V
,, COLUMN 4
Changes related to the - INVOLVED DIMENSION
-' -'SW&.v -* 'iPtpVpVi' 1 * \ 4
'; IS OBJECT
^ommm0B - : '
%SSnMI
5- ON PLANT? ' v ON EQUIPMENT?
/ ON'JeRSON? ?
islHuiNr--^
IN. PROCESS^
IIhen
fSggmmmm
m>M- mim1
` . V?
-
* ' ** V T * jgV#*jr5ei
y l T
/J
BflHlMipi
mm
EVENTS BEFORE?:,-, U V WIN I V.: *#b .W.v.?,
if evWafter?^^P
rnmmmm \ - * ' K* V-'* I
WHO
IS AFFECTED? WITNESSED? TRAINED INJURED? IS SUPERVISOR?
EXTENT OF DEVIATION
EFFECT? INJURY? PERSONAL PROTECTIVE
EQUIPMENT USED?
ORIGINAL ISSUE: 7/l|l/59
SC 005441
REVISED: 10/30/80
)
LAM006651
PAGE: 2 OF 2
"' f
I'*' 4
at....
.
v ?., - <
/
-
the'process to incl #c&onditlonsnecessar |
In? thTSlgfi..TM----
--------------It from happening "again the recommendations must eliminate!:
the unsafe actsf unsafe conditions* dr unsafe personal conditions!dentlfled In
the bottom row tn each branch of the diagram.
V59>x-
7. See attached diagram for example.
&' ?p'SPr
SC 005442
` # v^t; "' '*. `..4*T^ .f" '
-v>f
O
ORIGINAL ISSUE: 7/11/59
REVISED: 10/30/80
PAGE: 3 OF 5
LAM006652
I
* *V * ^ 4
i
* *** t
'* " *-
' ^'^V>:`C vA-i|Vf^^f^^tA7 >r injury *
. ^ **~ ' ** */* , ' *., ,.? *<;>#.;; - -
'
"t"'V hand under;'
.. '
.-* susnended load ,;- *-=
--
-.'- <! p a c
/.''aa;v/
., , . /ft^,^vT^. C\L-^' -- -. UMV- +l.'{"!.{
5 *
',
t * *
U*,*e, ',? i ,'>0 >* - - / -~
> ^ -''l '
'- ` >*-r '
> ';' 4>
1
'
-|*i
i ?'. ,, of the Injured
-'.' . . `V - ,
t'S' '*- ' f f. ~.``f '' 'r * &i.\ ''/,\M '' **
fs`- -3v f * *.* *1
: i^vPV
prior personal*
i
' . r''
fc -' %-v , J *%
, s **> -A-tt -^.'h ''l J1 * ,K.> '
>:>.* ,"'- r* *` ** ti ***'.1 i
.*
s'-' 5fr*-
/'i'
in hole ,y ^ :' . method
irfsert5^^!^r
did not install %and chec -* eyebolt v l^?* , f \
not cleaned out
error ; in
judgement
overfamiliarity I :
failure to '
obtain one
-
thread *':. .:r;
engagement
SC 005443
1 =Symbol
Event' oV':Y^Mf0 condition above was caused by item below
' '/.'
ORIGINAL ISSUE: 7/11/59
REVISED: 10/30/80
PAGE: 4 OF 5
LAIV1006653
APPENDIX II
PROCEDURES BULLETIN--texas city plant - miu
o
i
INJURY, ILLNESS, AND NEAR-MISS INVESTIGATION AND REPORTING
^
IS
ACCIDENT INVESTIGATION REPORT NO.
' (Call Loss Prevention
and Safety, 2235, for the number assigned to this investigation)
ail'S&M t&f' v'ffv" i y* isiuE batJF*^ -*V
^fPfT<vPI^f5liiNA^i3^AraWrB0^32:'^^^^pJ ; '*'*!' CONCERNED SUPERVISION (As Specified by the Approving General Supt.Jf
> SUBJECT: Investigation of
accident-,
xn
- (The first page of the*report should be written so that it may be used JA '/ ' alone' as a Plant Safety Bulletin ,if ^considered desirable by the Plant *
Manager/ It should contain the first three Sections only)"
;4 .
. ,. tv
^ ".V, *. ft
fcjsij. /Sj .'1/5.-./ vai'iis ,>=,;/
*.v -
' 'S *. //*-..>' jhiiji'iX:
V , './ -J.W- ' . i- SS*1.'
^ ' '.t .*
. ' - .>?,.- ft. V.T
,.X.T,rjf*" 'n / ' -Sjj* ^
r <*/*'' i.A
J 1l|H *4
-, ,, A,,, ,
This should be* covered in one. or two. sentence's including:
mapjQafgb**!*..'.
*
rill
....... ^..... ... r,,-s*,*,*k**.*m*xt**-&,
What the consieqquuiences wen
...
. - ,. What went wrong *
! JtuMRIItjK~r-*
What was goxng .on ** _
......................................... .
....................
...................... ...
(omit person's name but identify
cian, supervisor, office worker
... .....................
by occupation, operator,
etc.)
,/$ik
techni-
II. CAUSE AND CONTRIBUTING FACTORS
Be sure to identify root cause (Stair Step) and significant contributing factors. These concise statements should indicate consideration of any unsafe conditions, unsafe personal factors, or unsafe act involved. Action-agent combinations responsible for the event should be clearly identified.
III. RECOMMENDATIONS
Care should be exercised to make the recommendations practical and specific to eliminate the causes and contributing factors identified. Following each recommendation, persons responsible for action must be identified and target date for completion must be set.
SC 005444
ORIGINAL ISSUE: 7/11/59 | REVISED: 10/30/80
LAM006654
[pagejZofII
v,l APPENDIX II,
a5 PROCEDURE BULLETIN 1-Vexas city plant* * p-0112
;s
?. INJURY,' ILLNESS, AND NEAR-MISS INVESTIGATION AND REPORTING
f<n#'
IV..; DETAILS OF REPORT
''* ' fl '
"`- \'
a. ` Description -r .
', ..V.,,.
,,. ,,,,
............,,.v....._________________________
. ~ - j ,,< A chronological narrative in thedegree of detail necessary *;
V -W: to present a^cleax understanding of, the pertinent events
: - - v*,
leading up"'to; in the course ot^emd^fqll^idg^k'-iccxdeni^
b.,,. Findxngs
`Pertinent' facts and^infonnatioh collected _ lCithor,:6i
f*.. the committee as "a .result1 of interviews Afield observaatioi
.'4; and analysis1 of data should be;included in this section' ' ^.Osj^a^J^w?<^^tt:^fe^Sbtif^^>btcausl^b^lijnci: **-;v
dent!
m
paragraph in-" language' that; canbeundersto byall.^ln
`imiSSi
plant.
piiyiiciah * a* f'jSdingsS^^ai^lltj ura
S^fSIgfriSf^
n
' If the accident is' of suet anature^as to, have involved '*
k;
This, section is reserved for any .comments,.that ,1
oMifpf^rpev^etoftnifS'^^^eideeTr'sfifSa'fld^iif^f^pbettfflttiiini^e5nctc^i^^f^i?$ *^9'W" i;
mendatio:
aut iZii* jl'-jm
. _ead
vfr&pfryitvss
recom-
______
.
V..v DRAWINGS OR APPENDICES
* '-
JSIfp SI8III
Pr^.Ztv'-. \i-i
f- Include any drawings, sketches or other material that would aidft^l.%, ^:.
"h the reader to understand what went on and how to avoid a similar s.,s .occurrence.
VI. PERSONNEL
Listed under this heading should be the names and occupation of all personnel involved either as witnesses, supervision or colleagues of the injured.
-,
' INVESTIGATORS
-
;'.\;Vv }* :./ ,>
" 'K
005445
APPROVED BY:
DATE:
General Superintendent
CHAIRMAN
>
LAM006655
ORIGINAL ISSUE: 7/11/59 | REVISED: 1Q/3Q/80
PAGE-L0Fi-
APPENDIX II P-0112
INCIDENT BULLETIN
hft_A
Plantwide bulletin board notices of selected incidents/injuries, and near-miss events will be posted following review and approval of Superintendent of Manufacturing (or equivalent in other depart ments) of the affected area, the Superintendent of Personnel, and the Plant Manager using this form. If approved the first page of the report will be printed on this form.
illlliililliil
ORIGINAL ISSUE: 7/11/59
REVISED: 10/30/80
PAGE: 5 OF _5