Injury report form

Record the incident — Now is the time to put the incident down on paper, using injury report forms. Answer the questions who, what, when, where, why, and how. After getting all the information into the computer or down on paper, you can complete the required OSHAand company records of the incident. 

Depending on the seriousness or severity of the accident or injury, an accident report may simply consist of a filled-in company accident/injury report form or it may be a full written report. Proformas may be available in national standards. A full written report would cover ... 

After the appropriate medical attention is provided, accidents should be reported to the employee s immediate supervisor. The supervisor should then complete an injury report form fhat documents the initial findings. The form used for initially reporting an injury should be simple but informative. The form should indude the who, what, when, and where, and how (i.e., it is not only important to know if personal protective equipment was being used, but also how was it being used) of the inddent. A complete injury report will include the answers to the following questions ... 

You and your supervisor will complete an injury report form (forms can... 

Turn a copy of the injury report form into the Safety Coordinator by the next workday for review (keep a copy to review with your crew). 

C. The supervisor will complete the injury report form with all the necessary information regarding the exact nature of the injury. 

If there were injuries on the scene, complete report form 103. 

Most commercially available methylaluminoxanes are produced by careful reaction of water with trimethylaluminum (TMAL) in toluene. Reaction must be closely controlled to avoid what renowned organometallic chemist John Eisch called "a life threatening pyrotechnic spectacle" (16). Unfortunately, there have been explosions and injuries reported during MAO preparations. Water must be introduced at low temperature and in forms that moderate the potentially violent reaction. For example, water has been introduced as hydrated salts, ice shavings or atomized spray. Even with these precautions, explosive reactions have occurred. The overall reaction is given in eq 6.1. 

Penicillin-induced hepatotoxicity may not be as uncommon as has been thought. There have been three reviews. The first was a comparison of the assessment of drug-induced liver injury obtained by two different methods, the Council for International Organizations of Medical Sciences (CIOMS) scale and the Maria Victorino (M V) clinical scale (66). Three independent experts evaluated 215 cases of hepatotoxicity reported using a structured reporting form. There was absolute agreement between the two scales in 18% of cases, but there was no agreement in cases of fulminant hepatitis or death. The authors concluded that the CIOMS instrument is more likely to lead to a conclusion compatible with the specialist s empirical approach. 

An accident at work resulting in an over-three-day injury (that is, an employee being absent from work for over three days as a result of an accident at work) requires that accident report form F2508 be sent to the Local Authority within 10 days. 

Descriptive statistics are techniques used to describe a population or sample. One cannot draw conclusions using descriptive statistics. For example, suppose a safety manager collects information from accident report forms about the age of workers that suffered a back injury. The average age for the sample was found to be 45 years old. The only conclusion the safety manager can make is that the average age of those persons from which the sample was selected is 45 years old. He or she cannot conclude that the average age for all people ever suffering from a back injury is 45 years... 

Upon notification of an occupational injury or illness, the supervisor should complete a formal incident/accideut report aud, if possible, seud it with the injured employee to the medical professioual involved. The incident/accident report form must be completed and forwarded to the company medical department even if the employee receives medical treatment at the hospital and/or from a private physician. 

All near-miss incidents also must be reported on the Incident/Accident Report Form within 24 hours of occurrence. In place of indicating the result of the incident (i.e., actual personal or property damage), the reporting person should indicate the avoided injury or damage. 

HSE, Report of an injury or dangerous occurrence. Report Form F2508 (Rev 1/86), HMSO, London (1986)... 

What do I need to do to complete the OSHA 301 Incident Report You must complete an OSHA 301 Incident Report form, or an equivalent form, for each recordable injury or illness entered on the OSHA 300 Log. 

Over three-day lost time injury If there is an accident connected with work (including physical violence) and an employee, or self-employed person working on the premises, suffers an injury and is away from work or not doing their normal duties for more than three days (including weekends, rest days or holidays) but not counting the day of the accident, the responsible person must send a completed accident report form, F2508, to the enforcing authority within ten days. 

Appendix 15.2 provides a checklist of headings, which may assist in the collection of information. It is not expected that all accidents and incidents will be investigated in depth and a dossier with full information prepared. Judgement has to be applied as to which incidents might give rise to a claim and when a full record of information is required. All accident report forms should include the names of all witnesses as a minimum. Where the injury is likely to give rise to lost time, a photograph(s) of the situation should be taken. 

The OSHA 301 Injury and Illness Incident Report replaces the OSHA Form 101. For each recordable injury or illness on the 300 Log, complete an OSHA 301 Incident Report form, or an equivalent. The 301 is designed to accommodate lengthier, detailed information about the incident. Many employers use a workers compensation or an insurance form instead of the 301 Incident Report, or supplement a workers comp/insurance form by adding any additional information required by OSHA. Record the injury or dlness within seven calendar days of receiving information that it occrured. 

The components of the PWSD s Near Miss Program include three sections reporting, investigation, and correction. The PWSD developed a reporting form that enables an employee, supervisor, or manager to report an unsafe act or unsafe condition that could lead to an injury, property damage, or loss of process. The form also provides the employee with an option to indicate the potential severity (magnitude of the loss), the likely recurrence of the near miss, and any action taken to eliminate the unsafe condition or act. 

The laboratory supervisor should see that all serious injuries that require medical attention be reported by calling emergency response. All incidents that result in an injury or property damage are to be reported using an accident report form. 

Thus, accidents have many causes. Basic (root) causes lead to unsafe acts and unsafe conditions (indirect causes). Indirect causes may result in a release of energy or hazardous material (direct causes). The direct cause may allow for contact, resulting in personal injury or property damage or equipment failure (accident). You can use the accident report form found in Figure 8.2 to identify and analyze these three causes. 

Let us specifically discuss fraditional discipline for safety—a form of top-down control with negative consequences. I have met many managers who include a "discipline session" as part of the corrective action for an injury report. The injured employee gets a negative lecture from a manager or supervisor whose safety record and personal performance appraisal were tarnished by the injury. 

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