Accident investigations writing reports

Not all police duties are dangerous. Some duties, like writing reports, have no risk at all. Others, like traffic duty, offer very little risk. Still other duties, like investigating accidents, leave officers free of danger. 

It is easier to write about a culture that includes safety as a core value than it is to factually describe a situation in which the culture deteriorates over time, the effect the deterioration has on increasing risk and the position in which such deterioration places a safety professional. The following are excerpts taken from a report that was internally produced by BP Products North America (2005) pertaining to a fire and explosion that occurred on March 23,2005, at an owned and operated refinery in Texas City, Texas. As a result of that incident, 15 people were killed and over 170 were harmed. It is important to note that these excerpts, taken from the Executive Summary— Fatal Accident Investigation Report, represent a self-evaluation. 

It is not always necessary to prepare a formal written report of an accident investigation, but where it is, the techniques of good report writing should be followed. Key points on report writing are given below. 

The basic responsibility of the investigation board is to investigate the accident and write a report that documents the investigation, conclusions, and recommendations. The investigation should focus on the following ... 

Your company shonld have a formalized accident investigation procedure, which is followed by everyone. It should be set down in writing and end with a written report, using as a foundation your standard company accident investigation form. This may be a form developed by you (such as the example provided in Fignre 7.6). It may be yonr workers compensation form or an equivalent from your insurance carrier. 

Accident investigation notes are a record of the facts surrounding an accident that contain information about what people have witnessed. Writing good notes is important because they can be used to develop the final accident investigation report. 

MORT analysis. A detailed, comprehensive 1,500-item fault tree used primarily for mishap investigation. This valuable tool serves as a graphic guide for organizing and conducting an investigation and for writing the accident report. It may also be used as an appraisal or accident-prevention tool. 

Keep in mind that the chart is only a working tool to be used during the investigation to write the report and then to be discarded or filed with the background documentation therefore, neatness does not count, and many analysts make notes directly on the chart. For example, a description of the accident specifying the losses is entered near the top block. (If the analysis is being performed to examine conditions that could lead to future undesired events, the specific undesired event is described.)... 

The person who investigates the accident writes a report on his or her findings, to which are added any suggestions for remedial action. 

Effective observation and interviewing will be adequate for the majority of investigations and, when combined with the discipline imposed by good report writing, should ensure appropriate recommendations. However, there will be certain accidents and incidents which, because of their complexity, require the use of more advanced techniques. A full description of these techiiiques is beyond the scope of this chapter but key points are as follows ... 

---