AM : Accident / Incident Form

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Chapter: Accident Management 

 Accident / Incident Form

Accident/Incident Forms is a document used to report and record safety incidents, near misses, and hazards in the workplace. It's a standardized form that helps organizations to:

1. Identify potential safety risks

2. Investigate incidents

3. Implement corrective actions

4. Track safety performance

A typical Accident/Incident Form includes sections for:

1. Incident details (date, time, location, etc.)

2. Description of the incident or hazard

3. Type of incident (injury, illness, property damage, etc.)

4. Causes and contributing factors

5. Injuries or damage (if any)

6. Corrective actions taken or proposed

7. Follow-up actions and responsibilities

8. Signatures and approvals

Using the Accident/Incident Form helps organizations to:

1. Maintain accurate safety records

2. Identify trends and patterns

3. Improve incident reporting and investigation

4. Enhance safety awareness and training

5. Reduce incidents and injuries

6. Comply with regulatory requirements

The exact content and format of an accident/incident may vary depending on the organization, industry, or regulatory requirements.

Technical terms to be used in accident investigation and filling of reports related to accidents.

The Nature of Injury.

• Incised Wound: Straight cut. - Minor Injury.
• Laceration: irregular cut. -Minor Injury.
• Contused wound: Swelling. -Minor Injury.
• Bruise: Cut + Swelling. - Minor Injury.
• Punctured wound: Deep prick. - Minor Injury.
• Burn: Chemical, electrical, or fire. - Minor / Major Injury.
• Scald: Steam, hot liquids/solids—Minor/Major Injury.
• Asphyxia: Breathlessness. - Major.
• Shock: Nervous, Electrical. - Minor / Major Injury.
• Abrasion: Scratch, tearing of skin. - Minor injury

The severity of injury.

• Unconsciousness. - Major.
• Profuse bleeding. - Minor / Major Injury.
• Partial amputation. - Major Injury.
• Fatal—Major Injury.

The Agency—Causative Agent.

The subject, object, radiation, or person most closely related to the cause of injury/accident.

• Animals: - Insect, snake, wild, domestic, and so on.
• Boilers and Pressure Vessels: Steam boilers, superheated, condenser, digester pressure, piping, and so on.
• Chemicals: explosive, vapors, fumes, corrosive, poison.
• Conveyors: Belt, sprocket, chains & other types.
• Dust: Asbestos, silica, coal, lead, explosives & others.
• Electricity & Electrical Apparatus: Motor, generator, thermostat lamp, circuit breaker, etc.
• Elevators: Passenger or freight, electrical, steam, hydraulic & other.
• Fire: Ordinary, electrical, chemical.
• Hand tools: Axle, lever, chisel, file, hammer, screwdriver, and so on.
• Highly flammable & hot substances: lacquer steam, chemicals, LPG & others.
• Hoisting Apparatus: Crane, derrick, hoist, etc.
• Machines: Lathe, punch, press, band saw, drill, press & others.
• Mechanical power transmission equipment: Drive shaft, bearings, pulleys, and gears.
• Prime movers and pumps: Engine, compressor, blower fan.
• Radiation & radiating substances: radium, ultraviolet, x-rays.
• Working surface: floor, ramp, road, stair, ladder, scaffold, etc.
• Miscellaneous: floor opening, windows & others.

The Agency Part.

It is the particular part of the agency that is most closely associated with the event that has resulted in the injury.

The Accident Type.

According to the source of injury.

• Caught in between: crushing, pinching, or squeezing between moving or stationary objects.
• Struck by: an object causing impact or blow into a person.
• Struck against: injured by striking against a moving or stationary object.
• Fall of person: Same level.
• Fall of person: Different level.
• Abraded, punctured, and scratched: forceful pressing against rough, pointed, or hard substances.
• Overexertion: Springs, ruptures, strains, and so on.
• Contact (electrical current): with line electrical conductors, resulting in a shock or burn.
• Contact (temperature extremes): with hot or cold solids, liquids, or gases, resulting in burns or freezing.
• Contacts: radiation sources and caustic toxic and noxious substances by inhalation, ingestion, or absorption.

Unsafe Mechanical/Environmental Physical Condition:

• Inadequate mechanical guarding,
• Defective conditions of equipment: rough, slippery, sharp, corroded, cracked, inferior, and composition.
• Ladders, floors, chairs, piping, and so forth.
• Unsafe design or construction.
• Hazardous processes, operations or arrangements, piling, stacking, storage, congestion, crowding, overloading, aisles, and so on.
• Inadequate or incorrect illumination.
• Inadequate or incorrect ventilation.
• Unsafe dress or PPE/apparel.
• Obstructions due to bad housekeeping.

Unsafe Personal Acts.

Types of behavior that lead to injuries.

Working unsafely: improper lifting, hazardous placement, incorrect mixing of material, performing maintenance or repair on moving machinery, working under suspended solids, failure to take heed of warnings, adding chemicals speedily, incorrectly, at the wrong time, and so on.

• Performing operations without training, authority, and/or supervisory permission.
• Removing safety devises or altering their operations so they are ineffective.
• Operating at unsafe speed.
• Use of unsafe or improper equipment and tools.
• Using equipment’s or tools unsafely.
• Working under influence of alcohol or drugs.
• Horseplay, teasing, abusing, distracting attention of others.
• Failure to use attire, safety devices, and personal protective equipment.
• Failure to follow standard safe operating procedures.

The unsafe personal factor.

• Unsafe attitude.
• Lack of knowledge or skill.
• Bodily defects, faulty vision, poor hearing & so on.
• Nervousness, fatigue, and so forth.