Document 930exrn21rYNzx5yne2QkmyqL

M m a KIKOCH KOCH REFINING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING Ur\Q)ni-sdUA PLAINTIFF'S EXHIBIT f KRC-26 CORPUS CHRISTI REPINERY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING Document Number 23-020 Occupational Health & Safety Department Issue Date: 9-21-1992 Refinery.Manager Doc.#: 23-020 Corpus Christi Refinery Manager/OH&S Department PAGE 1 September 18, 1992 K010392 KiKOCH KOCH REFINING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING 1.0 INTRODUCTION This procedure provides guidelines for the management of occupational injuries and illnesses. It also outlines requirements for the prompt and consistent reporting of all related incidents and near misses and their investigation so that continuous improvement will occur. 2.0 POLICY This policy is to provide prompt accurate reporting and appropriate medical treatment of all work related injuries, illnesses and near misses for the protection of our human resources. 3.0 SCOPE This policy applies to all Koch employees, contractors, and visitors at the Corpus Christi Refinery of any of its' ancillary facilities. 4.0 PROCEDURE FOR REPORTING OCCUPATIONAL INCIDENTS REQUIRING MEDICAL ATTENTION 4.1 LIFE THREATENING OCCUPATIONAL INJURIES/ILLNESS IN THE FIELD: 4.1.1 The first responder to the occupational injury/illness will notify security, main gate 8596 or 8465 of location, #of persons involved, type of incident. 4.1.2 Security will notify Safety and Medical via pagers and radios of injured personnel. 4.1.3 Safety will pick-up medical personnel and transport them directly to the site. It will be the responsibility of the safety person in closest proximity to the medical department to advise medical of the pending transportation. 4.1.4 Medical treatment will be under the direction of the registered nurses and/or physician. Standing medical orders will prevail. Doc.#: 23-020 corpus Christi Refinery PAGE 2 K010393 September 18, 1992 IlKOCH KOCH RERNING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING 4.1.5 The first responder to the incident will communicate to security if #911 needs notification. 4.1.6 If feasible, seriously injured/ill persons will be transported directly to the medical center for treatment and stabilization until the ambulance arrives. This allows for maximum treatment in a less traumatic environment. 4.1.7 The above procedure applies to all employees on Koch premises including contractors during normal working hours, Monday through Friday 7:30 A.M. to 4:00 P.M. 4.1.8 HOLIDAYS, WEEKENDS, OFF HOURS: 4.1.8.0 The first responder to the occupational injury/illness will notify security, main gate 8596 or 8465 of location, #of persons involved, type of incident. 4.1.8.1 Security will notify the Shift Foreman and Laboratory First Aid Attendant of injured personnel. 4.1.8.2 The Laboratory First Aid Attendant will administer first aid treatment. If #911 is to be notified, the Lab Attendant will notify security. Any medical judgement calls above the limits of the Lab First Aid Attendant will be communicated to the medical person on call pager 880-1300. 4.1.8.3 SECURITY WILL NOTIFY THE MEDICAL COORDINATOR, SAFETY MANAGER, AND EMPLOYEE RELATIONS MANAGER AND SUPPORT SERVICES MANAGER ON ANY PERSON RECEIVING HOSPITAL TREATMENT, OR FATALITIES. 4.2 NON-LITE THREATENING OCCUPATIONAL INJURIES/ILLNESS 4.2.1 The Occupational Injured/111 employee will report incident directly to his/her immediate supervisor. 4.2.2 Treatment of the employee will take place in the Medical First Aid Department. DOC.#: 23-020 Corpus Christi Refinery PAGE 3 K010394 September 18, 1992 IlKOCH KOCH REFINING COMPANY .;: OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING 4.2.3 An incident causing an injury or illness will be communicated immediately to the Safety Department. 4.2.4 Medical follow-up will be directed by the Medical Coordinator. Any employee receiving treatment for an Occupational Illness/Injury must be cleared through the Medical Department. Worker's Compensation Claims require proper documentation and authorization. (See attached form). 4.2.5 If an employee's condition becomes more severe after leaving the plant, it is the employee's responsibility to notify rhe medical person on call - pager 880-1300 before going to a hospital or physicians office. If the medical person is unavailable, the Shift Foreman must be advised. 4.2.6 Any Occupational Illness or Injury resulting in lost time from work must be reported directly to the employee's supervisor and to the Medical Department. Vacation time or sick time cannot be substituted for occupational injuries or illnesses resulting in Lost Work Time. 4.2.7 HOLIDAYS, WEEKENDS, OFF HOURS: 4.2.7.1 The Injured/111 employee will report the incident directly to the Shift Foreman (this includes, all Koch employees and contractors.) Laboratory First Aid Attendants will attend to administering First Aid to the injury/illness. The Shift Foreman will be responsible for documentating and reporting the incident to Safety and Medical. 4.2.7.2 The Shift Foreman will notify Security if the injured or ill employee needs further medical assistance. 4.2.7.3 Transportation to a Medical facility will be arranged by Security. Non life threatening emergencies should be transported via company vehicle. Doc.#: 23-020 Corpus Christi Refinery PAGE 4 K010395 September 18/ 1992 KIKOCH KOCH REFINING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING 4.2.7.4 IF AN EMPLOYEE'S INJURIES REQUIRE FURTHER TREATMENT AT A MEDICAL FACILITY, SECURITY WILL NOTIFY THE MEDICAL COORDINATOR, SAFETY MANAGER, EMPLOYEE RELATIONS MANAGER, AND SUPPORT SERVICES MANAGER. 4.2.7.5 After receiving treatment, the injured/ill employee will report directly back to the Shift Foreman or Supervisor regarding their status. Transportation back to the plant will be via Yellow Cab. 4.3 All Koch employees who remain off work from Occupational Injury or Illness must report to the Medical Department on a weekly basis or after each physician visit. 5.0 INCIDENT REPORTING 5.1 An Incident is any situation that causes or has the potential to cause an injury, illness or property damage. All incidents must be reported immediately regardless of how minor it may seem. This will assure that the incident is investigated so that corrective action and improvement is not delayed. 5.2 Upon notification of an incident, the Supervisor will complete the "Supervisor's Immediate Report" Form. If applicable the injured employee is to give a factual description of the incident and sign and date the form. 5.3 The original copy of the "Supervisor's Immediate Report" shall be taken to the plant Medical Unit as soon as practical but no later than the end of supervisor's work day or shift. Copies of the report shall be given to the Plant Manager, Department Manager, Business Line Manager and Safety and Health Manager. 5.3.1 All reported incidents will be reviewed in the respective department morning meetings. 6.0 INVESTIGATION 6.1 An investigations report is required on all incidents. The supervisor is responsible for assuring that the investigation is completed within 48 hours of incident. Doc.#: 23-020 Corpus Christi Refinery PAGE 5 K010396 September 18, 1992 If KOCH KOCH REFINING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING 6.2 The completed Supervisor's Investigation Report form should be taken to the Safety and Health Manager and copies given to the Department Manager, Business Line Manager, Superintendent, Plant Manager and Leader of the Serious Incident Safety Team. 6.3 The leader of the serious incident investigation safety team will determine if a team investigation is necessary and will organize an appropriate team. If a team investigation is determined to not be needed, the supervisor will conduct a work group review using the Supervisors Investigation Report Form. 6.4 Action items, responsibility, and follow-up plans shall be completed and returned to the serious investigation safety team leader. The team leader will report to the central safety and health council on corrective action and major points. Investigation results will be communicated to the total involvement team. 7.0 RETURN TO WORK POLICY 7.1 All Koch Employees who have lost time from an occupational related injury or illness must receive clearance to return to work through the Medical Department. 7.2 All Koch Employees receiving treatment at an emergency room, hospital or under the care of a physician from an occupational related injury or illness must receive clearance to return to work through the Medical Department and have a signed release from his/her attending physician. 7.3 If an employee is returning to work on night shift, it his/her responsibility to make arrangements to bring the physician's signed release to the Medical Department between 7:30 A.M. - 4:00 P.M. prior to night shift or give to the shift foreman. 7.4 Restricted Duty Policy 7.4.1 Eligibility Doc.#: 23-020 Each Department Manager is responsible for surveying his area to determine if functions exist that an employee who is on restricted duty could perform. Before a person is moved to another Department for light duty, every effort should be made to use him in his usual Department. A list of temporary restricted duty jobs will be maintained by the Medical Coordinator. K010397 Corpus Christi Refinery PAGE 6 September 18, 1992 If KOCH KOCH REFINING COMPANY OCCUPATIONAL INJURY/ILLNESS AND INCIDENT REPORTING Candidates for restricted duty must have a note signed by a physician which identifies his limitations and restrictions before he is placed in a restricted duty job, and must have a signed release from a physician before he may return to his regular job duties. The employee should report to Medical when a light duty or full release is cotained and the appropriate supervisor will be notified by Medical when the employee is released to work. The Medical Coordinator will coordinate the Restricted Duty Program. Temporary restrictions shall be those that can reasonably expected to be resolved and render the employee fit to return to his/her regular job duties in a reasonable period of time. 7.4.2 Compensation Employees cleared for temporary restricted duty will be paid their regular rate of pay including scheduled rate adjustments. 7.4.3 Monitoring Employees placed on temporary restricted duty will be interviewed weekly by the Medical Department to determine status of their restriction. 8.0 RESPONSIBILITIES 8.1 It is the responsibility of all employees to immediately report ALL incidents, injuries and illnesses to their supervisor. Supervisors are responsible for assuring that the medical needs of the injured employee(s) are secured and for completing the Supervisor's Immediate report form and Investigation form. Failure to report or investigate incidents will result in disciplinary action. Last Page Doc.#: 23-020 Corpus Christi Refinery PAGE 7 K010398 September 18, 1992 Routing: Original to Medical Unit Copies to: Plant Manager, Department Manager & Safety/Health Manager Supervisor's Immediate Report Koch Corpus Christi Refinery Report ID______ 001 YR Incident Category - Check those that apply: [ ] Injury [ ] Motor Vehicle [ ] Health/Illness [ ] Property Damage [ ] Fatality [ ] Near Miss [ ] For Record Only Date of Time of Incident___/___/___ Incidentam pm Date Reported Time Incident Name of Supervisor:to Supervisor___/___/___ Reportedam pm Investigation Responsibility if other than Supervisor: _____________________ (Investigation sheet must be completed within 48 hours of Incident) Employee Name: DOB__________ ~ Employee S.S. Number // Employee Address:Phone Number() Employee Occupation:Location of Incident: Name of Job Task Performing at Time of Incident:______________________________________________ Witness(es): Incident Occurred During T/A?_____ Yes _____ No Overtime Involved?_____ Yes _____ No Length of Employment: ____Less than 1 Mo 6 Months -1 Yr 1 - 5 Yrs 5 -10 Yrs 10 - 20 Yrs > 20 Yrs Incident Potential: ____ OSHA Recordable Lost Time First Aid ____Business Interruption < $ 100,000 Business Interruption > $100,000 Health/Environmental Employee: Describe in Full How Incident Occurred: Employee: Describe in Full any Injury: Check Object or Condition Most Closely Related to Incident: ____ Body Placement____ Workstation Training Tools/Equipment____ Unfocused on Task Signature of Employee: Date: The supervisor shall fill out this report immediately upon learning of incident. The completed report should he taken to the Medical Unit and eopiea given to the Plant Manager, Department Manager, Superintendent and Safety and Health Manager* K010399  ir* ' .... v - Routing: Original to Safety and Health Department Copies: Plant Manager, Department Manager Investigation Report Koch Corpus Christi Refinery Report ID _______ 001 YR Incident Date:____/____ /____ Incident Category - Check those that apply: [ ] Injury [ ] Motor Vehicle [ Health Exposure [ ] Property Damage [ ] Fatality [ Near Miss [ For Record Only Investigation Team Members:________________________________________________________________________ Factual Summary of Incident: YES NO _______ 1. Was equipment or a hazardous condition(s) a contributing factor? If yes, answer the following. If no skip to Item 2. __________ 1.1 Did location/posit ion of equipment/materialscontribute to ahazardous condition? _______ 1.2 Did any defect(s)in equipment/tools contribute to thehazardouscondition(s)? _______ 1.3 Was the defective equipment recognized? _______ _______ _______ 1.4 Was the defective equipment reported? 1.5 Was the correct equipment/tools/materiaT used? 1.6 Did employee know where to obtain equipment/tools and material required for the job? _______ 1.7 Is there an adequate equipment inspection procedure(s) to detect the hazardous condition(s)? _______ _______ 1.8 Were adverse environment factors such as noise, temperature, solvents, gases, dusts, insects, etc. a factor? 1.9 Was the workspace insufficient? Please explain answers: _______ 2. Was job procedure(s) used a contributing factor? If yes answer the following. If no, proceed to Item 3. _______ 2.1 Is there a written or known procedure (rules) forthis job? _______ 2.2 Did procedure(s) cover factors that contributed to the accident? _______ 2.3 Did employee(s) know the job procedures? _______ 2.4 Did employee(s) deviate from known job procedure? _______ 2.5 Was employee capable of performing the job? Please explain answers:________________________________________________________________________________________ K010401 rr *> * - i i r , 1. Patient's Name (First, middle, last) WORK RESTRICTION EVALUATION 2. OWCP No. --i ----- --- ------------ ------------- - . -- ----------------------- ACTIVITY TYPE 3. Check the frequency and number of hours a day the worker is able to do the following specific types of activities. ACTIVITY FREQUENCY Continuous Intermittent NUMBER OF HOURS A DAY 01 23 4 567 a. Sitting b. Walking c. Lifting d. Bending' e. Squatting f Climbing g. Kneeling h. Twisting i. Standing 4. Check the lifting restriction. 0-10 lbs. 10-20 lbs. 20-50 lbs. 5a. Hand restrictions? No Yes -- (Check b, c, and d.) 5c. Pushing and pulling? Yes No 50-75 lbs. 75 & above lbs. 5b. Simple grasping? Yes No 5d. Fine manipulation? Z Yes Z No 8 6. Can the worker reach or work above the shoulder? Yes No 7. Can the worker use his/her feet to operate foot controls or for repetitive movement? Yes No 8. Can the worker operate a car, truck, crane, tractor, or other type of motor vehicle? Yes No 9. Are there cardiac, visual, or hearing limitations? No Yes -- (Describe) 10. Are there restrictions concerning heat, cold, dampness, height, temperature changes, high speed working, or exposure to dust, fumes or gases? No Yes -- (Describe) 11. Are interpersonal relations effected because of a neuropsychiatric condition? No Yes -- Describe (Ability to give and take supervision, meet deadlines, etc.) - -- -- DEGREE i .. _ RECOVERY 12a. Can the individual work eight hours a day? Yes No -- (Indicate when) 12b. If not eight hours, how many and when? 13. Do you anticipate the worker will need vocational rehabilitation services such as testing, counseling, training, or replacement to return to work? Yes No 14. Has the worker reached maximum improvement? Yes (Indicate when) No (Indicate when) 15. Remarks: (Restrictions from medication or other limitations) PHYSICIAN 16. Name 18. ADDRESS 17. Signature 19. Telephone No. 20. Date K010403