Sample Incident Investigation and Reporting Plan

1 @ Copyright 2002. All Rights Reserved. Contact: Incident Investigation and Reporting The purpose of this procedure is to outline the method that this facility willuse for Incident Investigation and Reporting . Incidents are defined as anyevents that cause or may have caused injury/damage to employees, thepublic, the environment, buildings and/or ScopeThe types of incidents covered by this plan Employee Near Miss (no injury occurs) Employee First Aid Accident (treated onsite) Employee Medical Treatment Accident (treated offsite) Chemical / Material Process Upsets or Catastrophic Unless otherwise specified by the Facility Manager, the current shiftleader is responsible for ensuring the completion of all Initial IncidentInvestigations and reports.

2 Form A should be used for incidents Form B should be used for incidents through Multipleforms should be completed if applicable to the Incident (s). The facility Safety Coordinator is responsible for ensuring thecompletion of all Main Incident Investigations and reports. Main IncidentInvestigation and reports are required for Incident types through Initial Incident InvestigationInitial Incident Investigation is the first Investigation done after an incidenthas been resolved. Initial Incident Investigations must be lead by the shiftleader or designee who has been trained and certified to perform theinvestigation per the facility s Incident Investigation and Reporting trainingprogram.

3 The initial Investigation committee should consist of at least twoother shift personnel and include contractors if involved in the Initial Incident Investigation forms and all other pertinentinformation ( samples , witness reports, photographs, etc.) should beforwarded to the facility Safety Coordinator as soon as the initialinvestigation is complete. @ Copyright 2002. All Rights Reserved. Contact: Main Incident InvestigationMain Incident Investigations are follow-up investigations to initial incidentinvestigations. Main Incident Investigations must be lead by an individualwho has been trained and certified to perform the Investigation per thefacility s Incident Investigation and Reporting training program.

4 Membersof the Investigation committee should avoid including those involved in theincident. Exclude supervisors, designers, and managers of the employeesand/or processes involved in the Incident . Employees / operators (notinvolved in the Incident ) that are familiar with the job/processes should bepreferred committee members. Incidents involving chemical releases orother environmental impact must include the facility environmentalcoordinator. The facility safety coordinator should choose the committeeleader and both must approve all committee members. Committee sizeshould be between 5 to 10 Investigation committee will use JSA (Job Safety Analysis) for incidenttypes through where the Incident only involved one JSA method used is the one specified by OSHA in document all other incidents, Fault Tree Analysis or Change Analysis will beused as outlined in facility document , The committee isresponsible for selecting the analysis method.

5 The committee can only doone analysis method per Incident main Incident Investigation reports should be completed no later than 7days after the Incident . An interim report should be issued if theinvestigation is not complete within 10 days. A final report should beissued once the Investigation is committee members must sign/approve the final Investigation not on the committee are not allowed to modify/approve theinvestigation Distribution of final reports should be as Incident types through and Manager, Facility Safety Coordinator, All shift supervisorsNote: Shift supervisors should review Incident Investigation reportswith their shift personnel at the next shift safety Incident types , and @ Copyright 2002.

6 All Rights Reserved. Contact: Manager, Facility Safety Coordinator, All shift supervisors,Facility Environmental Coordinator, Corporate Safety Coordinator,Corporate Environmental CoordinatorIf chemical release exceeded a reportable quantity, copy of theincident Investigation report should be sent to the LEPC and SERC within 10 days after the : Shift supervisors should review Incident Investigation reportswith their shift personnel at the next shift safety RecommendationsAll recommendations should be resolved as soon as possible. Notecompletion time on Incident forms/final reports, if allrecommendations are completed before completion of the incidentform/final report.

7 Enter Work Maintenance Request numbers onthe Incident form/final report, if a work request is issued to resolve arecommendation. For other recommendations that are notresolvable by operations or maintenance personnel, enter arecommendation request through the facility RecommendationResolution System (RRS). Record the RRS tracking number on theincident Investigation form/final report.