Document evpqLrDeOOwbebwXOpbX0mqqM

February 23 f 1962 Mr. Clyde C. Ruddlck, Manager Safety and Plant Protection Pittsburg Plate Glass Company One Gateway Center Pittsburgh 22, Pennsylvania Dear Clyde: We have recently revised our accident investigation farm and I am attaching a copy, along with cover letter to all supervisors. The form is printed on pink paper so that it will stand out and r mind everyone that this demands immediate attention. We require that all accidents be investigated and the accident investigation report be in the hands of the Safety Department within 2U hours. The changes in this form are the results of discussions and suggestions from the supervisors themselves in training sessions. VJe have been using this new form far a month now and feel that our supervisors are doing a much more thorough job of investigation than they have in the past. Actually, the only changes that took place, other than the color of the paper and the rearrangement of the questions, was th addition of three new questions . These are: 1. Was this accident investigated at the scene of the accident? 2. Was the injured person present when report was filled out? 3. In your opinion, what is the reason for the attitude factor? 1 feel that'this last question has nade the supervisor and the employee stop and think before checking "Inattention" , which is by far the most popular attitude factor. Regards, HPN:gw attachments Howard P. Nelson Safety and Training Director | BB 0013778 | 't r> c PITTSBURGH PIATE GLASS CCMPAHT Chemical Division Lake Charles> La< Data: To: Frans January 26, 1962 All Supervisors Howard P0 Nelson '^v Subjects Accident Investigation Fora Attached is a copy of the now accident investigation form which has been revised, based on your suggestions and recommendations at the last supervisory se33ion Wiich was conducted on this sub ject. The first thing you will notica is the color, which X3 intended to make them stand out and remind everyone that this form should be handled as soon as possible. Basically, the farm has just been rearranged in order to make it easier to fill out when mak ing carbon copies. Two questions have been added to tho front of the form which should be simple to answer. The question on the rear of the form, pertaining to the attitude factor, was suggested by several supervisors and should stimulate more thinking into the underlying causes of tho factors involved in uroafa acta. This form will go into use on Fobruary 13 1962, HPNigw attachment Distribution Schlegel Melton Brown, A.C, Vau^aan Bussell Cook Hollinger Cleary Cutler Payne Duncan Spalding LaFleur,3,0. Corley Atwell Mobley Taylor McChristian Hathorn Allison DeWoody ^ollenger Tinnes Arnett Ashton Fuller Bridges,C.W, Khoury White Guillotte Hannon Davis,D.C, Welch Burns,C.A, Anderson Wade Kaspar Walker Harper King Morgan Estes McEntire Hann Jordan Provost Hickerson Phillips Simpson First Aid Prather I BB 0013779 Mi BATH CO. cc PITTSBURGH PLATE GLASS COMPANY CHEMICAL DIVISION Lake Charles, La. IK MI4MB SUPERVISOR'S REPORT OF ACCIDENT INVESTIGATION The unsafe acts of persons and unsafe conditions that cause accidents can be corrected only when they are known specifically. It is the Supervisor's responsibility to FIND them; NAME them, and STATE the REMEDY for them in this report. Name of Injured:_______________ Department:___________________ Time of Accident--Date: Time of first-aid treatment--Date: Time of your investigation--Date:. Where did accident occur?______ Occupation: .Badge No.: .Hour: .Hour: Hour:. (Be specific as to location) ------------ Age: Hire Date:__ A. M. _P. M. A.M. _P. M. A.M. J. M. Was this accident investigated at the scene of the accident? Yes Q No If not, explain_____.____ _____________________________________________________ Was the injured person present when report was filled out? Yes Q No ^j^If not, explain_______________________________________________________________ Describe the INJURY:. Describe the ACCIDENT: (State what the injured was doing and the circumstances leading to the accident): UNSAFE Condition What was unsafe about the machine, tool, equipment, or premises?. WHY, IN YOUR OPINION, DID UNSAFE CONDITION EXIST? Check 0" one item or write answer on line 3. 1. Not recognized as unsafe condition. 2. Q Hidden defects. eBB 0&13780 | c UNSAFE Act What did anyone do, or fail to do, that led to this accident?. ( V r',* WHAT, IN YOUR OPINION, WAS THE PRIMARY FACTOR INVOLVED IN THE UNSAFE ACT Check fpf one item or write answer on line 8. Attitude Factors 1. Disregard for instructions. 2. Failure to understand instructions. 3. Temper 4. Q Nervous, excitable, etc. 5. Inattention 6. Indifference 7. Impatience 8.___________________________________ In your opinion, what is the reason for the attitude factor? Lack of Information Factors Check |Tf one item or write answer in line 3. 1. Q Unaware of safe practice. 2. 0 Unconvinced that practice is unsafe. 3. COMMENTS:_____________________________ Skill Factors Check jTf one item or write answer in line 2. 1. 0 Unpracticed or unskilled. 2. ________________________ __ Was any disciplinary action necessary?. Did this accident have potential to cause serious injury?. (If so, explain)_____________________________________ What action have you taken to prevent a repeat accident?. Supervisor: ----------- . . Reviewed and Approved By: (If so, explain) Date: Date: | BB 0013781 i