Incident Investigation

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Learning From the Unexpected

Incident Investigation

Even when you and your staff do everything possible to prevent injuries and illnesses at work, you still need to be prepared for the unexpected. When incidents, injuries, or even close calls occur, you need to find out exactly what happened and how it can be prevented from happening again.

In the language of occupational health and safety, that means doing an “Incident Investigation”. Although it sounds intimidating, the goal of an investigation is simple and proactive: to learn from the unexpected.

Incident investigations are not about pointing fingers or laying blame. That’s counterproductive. The whole point is to work together to make your store as safe as possible for both staff and visitors.

This module will help to take you through the steps of completing an incident investigation and written report.

What Needs to be Investigated?

Employers are required by law to formally investigate incidents that:

  • Resulted in serious injury to a worker or the death of a worker
  • Resulted in injury to a worker requiring medical treatment
  • Had the potential to cause serious injury

In other words, employers have a responsibility to carefully examine and document any undesirable event that resulted - or could have resulted - in an injury or illness requiring medical care beyond first aid.

What Needs to be Reported?

Some incidents need to be reported to the workers' compensation system. Failure to investigate and report incidents could result in prosecution.

In BC, employers have to report certain serious incidents to WorkSafeBC immediately, whether there is an injury or not. As they apply to retail, this would include, for example:

  • Any incident that results or could result in a fatality or serious injury
  • A major leak or release of a dangerous substance
  • A major structural failure or collapse of your building
  • Any serious mishap

This requirement is similar in all Canadian jurisdictions. If in doubt, report it or check the occupational health and safety requirements for your province or territory.

How to do an Investigation

In retail, serious incidents typically don’t happen all that often. Many convenience store employers have never had to report an incident before, so this section outlines the investigation process in simple steps.

Use an investigation report form to help guide you and write things down as you go.  You may need to submit a report, so it is helpful to start using it as a guide from the beginning.

Step 1: Take Immediate Action

  • Take steps to prevent injury or damage. Keep the situation from getting worse
  • Inform workers of the hazard and what is being done to control it
  • Protect the scene of the incident until the investigation is finished
  • Collect any information you can. Get the names of witnesses, take note of anything that looks like it might be evidence

Step 2: Gather Evidence

Gathering evidence will help you get a clear picture of what happened. Try to fill in all the blanks that led up to the incident and what contributed to it – there are usually several causes, not just one. Try to separate the facts from mere speculation or conjecture.

Look for clues from the scene of the incident:

  • Take pictures and/or make a sketch
  • Take measurements
  • Take samples of substances
  • Note the environmental conditions that may apply, such as lighting, weather, noise, and housekeeping issues (eg: clutter, spills, tripping hazards, etc.)
  • Check your written safe work instructions – was anything posted in writing to cover this situation?

Get information from the people involved (eg: workers, supervisors, witnesses):

  • Ask questions that encourage more than “yes” or “no” answers
  • Try to be objective. Don’t “lead” the person or jump to conclusions. Don’t make the person feel like they are being blamed
  • Ask workers if they have any ideas about what should be done in the future

Step 3: Put the Evidence in Order

  • Put the evidence in chronological order – from beginning to end
  • Check to make sure that each event follows from the one before it. Try to fill in any gaps

Step 4: Analyze Your Information

Ask why the incident occurred. Asking “why” will help to get at the root causes underlying the event. Some of the “whys” may be obvious, but there are usually other, less obvious causes at work too. Consider:

  • Was someone acting unsafely? For example, were people fooling around? Not following safety rules? Not wearing protective equipment? Using a piece of equipment improperly?
  • Were conditions unsafe? For example, was there a lack of training or supervision? Was visibility limited? Was the area congested or messy?
  • Are there adequate written instructions and training? For example, are written instructions available? Are they complete? Are they missing steps or information?

Sometimes the root cause of an incident goes back to a management problem. This can make it hard to be objective. Management problems can be corrected, but only if they’re identified first. Ask yourself if there could be improvements made in policy, supervision, accountability, resource allocation and in providing training and instruction.

Step 5: Correct the Problem

Work together with staff to correct the problem and reduce the chance of a similar incident happening again. Get help from an expert if you need more information and advice. Tackle the problems that pose the highest risk first.

Make sure your solutions address the problem without creating new problems.

Step 6: Write an Investigation Report

You’re required to write a report to explain what happened and what you’re doing to keep it from happening again.

The report needs to include information that answers the questions WHO, WHERE, WHEN, WHAT, WHY and HOW. Click here for a blank sample investigation report form.

As noted above, this report may have to be submitted to under workers' compensation requirements. Whether you have to submit it or not, keep a copy of the report on file for at least 2 years.

Step 7: Follow Up

Make sure the solution was implemented and that it is still working. If it’s not working, try something else.

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