Guide for Identifying Causal Factors & Corrective Actions



Guide for Identifying Causal Factors & Corrective Actions Incident No.:      

|1. EQUIPMENT |

|Y N |1.0 Was a hazardous condition(s) a contributing factor? (If yes, answer the following. If no, got to 2. |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Did any defect(s) in | |Review procedures for inspecting, reporting, maintaining, repairing, replacing, or |

| |equipment/tools/material contribute to | |recalling defective equipment/tools/ material used. |

| |hazardous condition(s)? | | |

|Y N |Was the hazardous condition(s) | |Perform job safety analysis. |

| |recognized? | |Improve employee ability to recognize existing or potential hazardous conditions. |

| | | |Provide test equipment, as required, to detect hazard. Review any change or |

| | | |modification of equipment/ tool/material. |

| | | | |

| | | |Train employees in reporting procedures. |

| |Was the hazardous condition(s) reported? | |Stress individual acceptance of responsibility. |

| | | | |

|Y N |Was employee(s) informed of the hazardous| | |

| |condi-tion and the job procedures for | |Review job procedures for hazard avoidance. |

| |dealing with it as an interim measure? | |Review supervisory responsibility. |

| | | |Improve supervisor/ employee communications. |

|Y N | | |Take action to remove or minimize the hazard. |

|1. EQUIPMENT |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was there an equip-ment inspection | |Develop and adopt procedures (ex. an inspection system) to detect hazardous |

| |procedure to detect the hazardous | |conditions. |

| |condi-tion(s)? | |Conduct test. |

|Y N |Did the existing equipment inspection | |Review procedures. |

| |procedure detect the hazardous condition?| |Change frequency or comprehensiveness. |

| | | |Provide test equipment as required. |

| | | |Improve employee ability to detect defects and hazardous conditions. |

| | | |Change job procedures as required. |

|Y N |Was the correct equipment/tool/ material | |Specify correct equipment/ tool/material in job procedure. |

| |used? | | |

|Y N |Was the correct equipment/tool/ material | |Provide correct equipment/ tool/material. |

| |readily available? | |Review purchasing specifications and procedures. |

| | | |Anticipate future requirements. |

|Y N |Did employee know where to obtain | |Review procedures for storage, access, delivery, or distribution. |

| |equipment/tool/ material required for the| |Review job procedures for obtaining equipment/ tool/material. |

| |job? | | |

|Y N |Was substitute equip-ment/tool/material | |Provide correct equipment/tool/material. |

| |used in place of correct one? | |Warn against use of substitutes in job procedures and in job instruction. |

|1. EQUIPMENT |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Did the design of the equipment/tool/ | |Review human factors engineering principles. |

| |material create operator stress or | |Alter equipment/tool/material to make it more compatible with human capability and |

| |encourage operator error? | |limitations. |

| | | |Review purchasing procedures and specs. |

| | | |Check out new equipment and job procedures involving new equipment before putting into|

| | | |service. |

| | | |Encourage employees to report potential hazardous conditions created by equipment |

| | | |design. |

|Y N |Did the general design or quality of the | |Review criteria in codes, standards, specifications, and regulations. |

| |equipment/tool contribute to a hazar-dous| |Establish new criteria as required. |

| |condition? | | |

|Y N |List other causal factors in “Comment” | | |

| |column. | | |

|2. ENVIRONMENT |

|Y N |2.0 Was the location of equipment/materials/employee(s) a contributing factor? (If yes, answer the following. If no, got to 3. |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |2.1 Did the location/ position of | |Perform job safety analysis. |

| |equipment/ material/employee(s) | |Review job procedures. |

| |contribute to the hazardous condition? | |Change the location, position, or layout of the equipment. |

| | | |Change position of employee(s). |

| | | |Provide guard-rails, barricades, barriers, warning lights, signs, or signals. |

|2. ENVIRONMENT |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was the hazardous condition recognized?| |Perform job safety analysis. |

| | | |Improve employee ability to recognize existing or potential hazardous conditions. |

| | | |Provide test equipment, as required, to detect hazard. Review any change or |

| | | |modification of equipment/ tool/material. |

| | | | |

| |Was the hazardous condition reported? | |Train employees in reporting procedures. |

| | | |Stress individual acceptance of responsibility. |

| |Was employee(s) informed of the | | |

|Y N |hazardous condition and the job | | |

| |procedures for dealing with it as an | |Review job procedures for hazard avoidance. |

| |interim measure? | |Review supervisory responsibility. |

| | | |Improve supervisor/ employee communications. |

|Y N | | |Take action to remove or minimize the hazard. |

|Y N |Was employee(s) supposed to be in the | |Review job procedures and instruction. |

| |vicinity of the equipment/material? | |Provide guard-rails, barricades, barriers, warning lights, signs, or signals. |

|Y N |Was the hazardous condition created by | |Change lighting or layout to increase visibility of equipment. |

| |the location/ position of equipment/ | |Provide guardrails, barricades, barriers, warning lights, signs or signals, floor |

| |material visible to employee(s)? | |stripes, etc. |

|Y N |Was there sufficient workspace? | |Review workspace requirements and modify as required. |

|2. ENVIRONMENT |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Were environmental conditions a | |Monitor, or periodically check, environmental conditions as required. |

| |contrib-uting factor (ex. illumination,| |Check results against acceptable levels. |

| |noise levels, air contami-nants, | |Initiate action for those found unacceptable. |

| |temperature extremes, ventilation, | | |

| |vibration, radiation)? | | |

|Y N |List other causal factors in “Comments”| | |

| |column. | | |

|3. PEOPLE |

|Y N |3.0 Was a hazardous condition(s) a contributing factor? (If yes, answer the following. If no, got to 4. |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was there a written or known procedure | |Perform job safety analysis and develop procedure. |

| |(rule) for this job? | | |

| | | | |

| |Did job procedures anticipate the | | |

|Y N |factors that contributed to the | |Perform job safety analysis and change job procedure. |

| |accident? | | |

| | | | |

|3. PEOPLE |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Did employee(s) know the job procedure?| |Improve job instruction. |

| | | |Train employees in correct job procedures. |

| |Did employee(s) deviate from the know | | |

| |job procedure? | | |

|Y N | | |Determine why. |

| | | |Encourage all employees to report problems with an established procedure to |

| | | |supervisor. |

| | | |Review job procedure and modify if necessary. |

| | | |Counsel or discipline employee. |

| | | |Provide closer supervision. |

|Y N |Was employee(s) mentally and physically| |Review employee requirements for the job. |

| |capable of performing the job? | |Improve employee selection. |

| | | |Remove or transfer employees who are temporarily, either mentally or physically, |

| | | |incapable of performing the job. |

|Y N |Were any tasks in the job procedure too| |Change job design and procedures. |

| |difficult to perform (ex. excessive | | |

| |concen-trations or physical demands)? | | |

|Y N |Is the job structured to encourage or | |Change job design and procedures. |

| |require deviation from job procedures | | |

| |(ex. incentive, piece-work, work pace)?| | |

|Y N |List other causal factors in “Comment” | | |

| |column. | | |

|3. PEOPLE |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was lack of personal protective | | |

| |equip-ment or emergency equipment a | | |

| |contrib.-uting factor in the injury? | | |

| | | | |

| |Was appropriate personal protective | | |

| |equipment (PPE) specified for the task | | |

| |or job? | | |

| |Was appropriate PPE available? | |Review methods to specify PPE requirements (e.g. completing a Hazard Assessment Form).|

|Y N |Did employee know that wearing | | |

| |specified PPE was required? | | |

| |Did employee know how to use and | | |

| |maintain the PPE? | | |

| | | |Provide appropriate PPE. |

| | | | |

|Y N | | |Review job procedures. |

| | | |Improve job instruction. |

|Y N | | | |

| | | | |

| | | | |

| | | |Improve job instruction. |

| | | | |

| | | | |

|Y N | | | |

|Y N |Was the PPE used properly when the | |Determine why and take appropriate action. |

| |injury occurred? | |Implement procedures to monitor and enforce use of PPE. |

|Y N |Was the PPE adequate? | |Review PPE requirements. |

| | | |Check standards, specs, and certification of the PPE. |

|3. PEOPLE |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was emergency equipment specified for | |Provide emergency equipment as required. |

| |this job (ex. emergency showers, | | |

| |eyewash fountains)? | | |

| |Was emergency equipment readily | | |

| |available? | | |

|Y N | | |Install emergency equipment at appropriate locations. |

| |Was emergency equipment properly used? | | |

| | | | |

| |Did emergency equipment function | | |

| |properly? | |Incorporate use of emergency equipment in job procedures. |

|Y N | | | |

| | | | |

| | | |Establish inspection/monitor-ing system for emergency equipment. Provide for |

| | | |im-mediate repair of defects. |

|Y N | | | |

|Y N |List other causal factors in “Comments”| | |

| |column. | | |

|4. MANAGEMENT |

|Y N |4.0 Was a management system defect a contributing factor? (If yes, answer the following. If no, stop. |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was there a failure by supervision to | |Improve supervisor capability in hazard recognition and reporting procedures. |

| |detect, anticipate, or report a | | |

| |hazardous condition? | | |

|4. MANAGEMENT |

| |Causal Factors |Comment |Recommended Corrective Action |

|Y N |Was there a failure by supervision to | |Review job safety analysis and job procedures. |

| |detect or correct deviations from job | |Increase supervisor monitoring. |

| |procedure? | |Correct deviations. |

|Y N |Was there a super-visor/employee review| |Establish a procedure that requires a review of hazards and job procedures |

| |of hazards and job procedures for tasks| |(preventative actions) for tasks performed infrequently. |

| |performed infrequently? | | |

|Y N |Was supervisor responsibility and | |Define and communicate supervisor responsibility and accountability. |

| |accountability adequately defined and | |Test for understandability and acceptance. |

| |understood? | | |

|Y N |Was supervisor adequately trained to | |Train supervisors in accident prevention fundamentals. |

| |fulfill assigned responsibility in | | |

| |accident prevention? | | |

|Y N |Was there a failure to initiate | |Review management safety policies and level of risk acceptance. |

| |corrective action for a known hazardous| |Establish priorities based on potential severity and probability of recurrence. |

| |condition that contributed to this | |Review procedure and responsibility to initiate and carry out corrective actions. |

| |accident? | |Monitor progress. |

|Y N |List other causal factors in “Comment” | | |

| |column. | | |

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