For the Hamlet, N.C. Chicken Processing Plant fire, imagine yourself doing an accident investigation of the accident, write-up a description of the investigation. Note: You may fabricate (“make-up”) as many details as you need. Note: You don’t include the Initial Response phase of the investigation…..the scene has already been made safe and secured for the investigation.The write-up should include:A description of the fact-finding activities you would do, with details about: the evidence you might collect, interviews you would conduct, and documents you would review.A listing of the facts you find.A “Why Tree” analysis of the facts you find, specifically listing the causal factors (direct causes, contributing causes, root causes)The recommendations you make for corrective actionNote: Each root cause you identify must have at least one (1) recommendation for correctionSources of InformationMore details on the attachment also I have provided some sources you can use as well if you have other sources you use them.


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Model Safety Program
DATE: _____________
SUBJECT: Standard Practice Instruction for Accident Investigation and Reporting
RESPONSIBILITY: The company ________________________ is _________________.
He/she is solely responsible for all facets of this program and has full authority to make
necessary decisions to ensure success of the program. The ________________ is the sole person
authorized to amend these instructions and is authorized to halt any operation of the company
where there is danger of serious personal injury.
Standard Practice Instruction for Accident Investigation
1. Written Program.
2. General Requirements.
3. Accident Investigation Team Composition.
4. Accident and Incident Reporting.
5. Accident Investigation.
6. Job Hazard Analysis Review.
7. Administrative Controls.
8. Medical Management.
9. Accident Trend Analysis.
10. Training and Education.
11. Behavior Modification and Attitude.
(YOUR COMPANY) Accident Investigation Program
1. Written program. (YOUR COMPANY) will review and evaluate this standard practice
instruction on an annual basis, or when changes occur that prompt revision of this
document, or when facility operational changes occur that require a revision of this
document. Effective implementation requires a written program for job safety, health,
that is endorsed and advocated by the highest level of management within this company
and that outlines our goals and plans. This written program will be communicated to all
required personnel. It encompasses the total workplace, regardless of number of workers
employed or the number of work shifts. It is designed to establish clear goals, and
DECISION POINT A company policy should be established that delineates
who will perform accident investigation. The accident investigation should be
used in conjunction with the job hazards analysis program.
Examples of employees that could form an accident investigation team:
1. Safety Officer
2. Supervisors
3. Facility Engineer
4. Safety Committee
5. Employees with knowledge of accident causation, investigation procedures, and
knowledge of the job being performed
6. Union Representative
7. “Outside” Accident Investigations Officer
8. Local Government
2. General requirements. (YOUR COMPANY) will establish accident investigation
procedures, and improve operational procedures through the use of this document.
Preventing future workplace injuries in our company is the principle purpose of accident
investigation. This document will provide a basis for studying and recording the reasons
an accident occurred, identifying existing or potential job hazards (both safety and
health), and determining the best course of action to take to reduce or eliminate these
3. Accident investigation team composition. The accident investigation team will be
composed of the following:s
Accident Investigation Team
4. Accident and incident reporting. The (YOUR COMPANY) Hazard Report will be
used by all employees to report potential or known hazards. The following procedures
4.1 Person reporting hazard:
4.1.1 Notify department supervisor of the hazard.
4.1.2 Accomplish lock-out/tag-out if required on the machine.
4.1.3 Fill out required sections of the hazard report.
4.1.4 Forward report immediately to the safety officer.
4.2 Supervisor:
Notify all affected workers of hazard.
Notify maintenance of hazard, if required.
Ensure hazard is properly marked and controlled.
Contact Safety Officer if needed.
5. Accident Investigation. Accident investigation is primarily a fact-finding procedure; the
facts revealed are used to prevent recurrences of similar accidents. The focus of accident
investigation will be to prevent future accidents and injuries to increase the safety and
health of all our employees.
5.1 Immediate concerns.
Ensure any injured person receives proper care.
Ensure co-workers and personnel working with similar equipment or in
similar jobs are aware of the situation. This is to ensure that procedural
problems or defects in certain models of equipment do not exist.
Start the investigation promptly.
5.2 Injury and Illness Incident Report. OSHA form 301 or a standardized investigation
report form which details specific company requirements for investigation will be
developed and used to gather data to determine causes and corrective actions. As a
minimum the form will contain the following areas of concern.
Accident investigation form data.

Case Number
Injured employee’s name
Date and time of injury
Social Security Number
Occupation or task being performed when injured
Shift and department
Company ID number
Employee’s address
Length of service
Length of time at specific job
Time shift started
Overtime length when injury occurred
Physician’s and hospital name (if transported)
Type of injury
Resulting fatalities
Description and analysis of accident
Complete accident tree
Action taken to prevent recurrence and person
Employee’s statement
Witnesses’ statement
Employer’s statement
Person completing form and date
Person(s) reviewing form and date
5.3 Reviewers. All accident investigation reports will be reviewed by a member of
management responsible for the department/section involved to ensure pertinent
information in transmitted to all concerned and remedial action(s) taken.
Accident Investigation Review Team
Accident Investigation Team
Department Manager
Safety Officer
Union Committee representative
Supervisor of injured employee
5.4 Accident investigation final report. The final report will be numbered in the upper
right hand corner, Page of Pages. The report will include but is not limited to the
Investigation report form and pertinent data
Photographs/drawings/exhibits of scene
Narrative of accident
Sequence of events
Contributing information
Findings and recommendations of review team
Action items and completion dates
Responsible persons
Follow-up procedures to ensure completion
5.4.10 Distribution list
6. Job Hazard Analysis. This employer will identify through the use of information
sources and screening surveys, jobs that place employees at risk. After any accident or
near miss the task or job in question will have a job hazard analyses routinely performed
by a qualified person(s). This analysis will help to verify that all required actions are
being taken to determine if risk factors for a work position have been reduced or
eliminated to the maximum extent feasible.
6.1 The following personnel or job positions are qualified to perform job hazard analysis
surveys for this company.
Personnel Qualified to Perform Job Hazard Analysis
6.2 Work Station Analysis. Work station analysis will be conducted to identify risk
factors present in each job or workstation.
7. Administrative Controls. Once data has be gathered from the accident investigation
report, company administrative controls will be used where needed to eliminate or reduce
the frequency, and severity of accidents and near misses. Examples of administrative
controls include the following:
7.1 Reducing the production rates and or line speeds where possible.
7.2 Providing rest pauses to relieve fatigued muscle-tendon groups.
7.3 Increasing the number of employees assigned to a task to alleviate severe conditions,
especially in lifting heavy objects.
7.4 Using job rotation, used with caution and as a preventive measure, not as a response
to physical symptoms. The principle of job rotation is to alleviate physical fatigue
and stress of a particular set of muscles and tendons by rotating employees among
other jobs that use different muscle-tendon groups. If rotation is utilized, the job
analyses must be reviewed to ensure that the same muscle-tendon groups are not
used when they are rotated.
7.5 Providing sufficient numbers of standby/relief personnel to compensate for
foreseeable upset conditions on the line (e.g., loss of workers).
7.6 Job enlargement. Having employees perform broader functions which reduce the
stress on specific muscle groups while performing individual tasks.
7.7 Machine maintenance/guarding. Ensure regular maintenance is performed on
machines/tools used by employees are properly guarded and that maintenance is
routinely performed.
7.8 Employee training. Ensure all employees are properly trained in the hazards
associated with the job before work is performed unsupervised.
DECISION POINT OSHA Recommendation – Where health care providers are not
employed full-time, the part-time employment of appropriately trained health care
providers is recommended.
8. Medical Management.
_______________________ will manage the program.
Employees of each work shift should have access to health care providers or designated
alternates in order to facilitate treatment, surveillance activities, and recording of
information. During accident investigation the medical management program will as a
minimum address the following issues:
8.1 Injury and illness recordkeeping.
8.2 Early recognition of problems such as strains and muscle fatigue that could lead to
8.3 Systematic evaluation and referral.
8.4 Conservative treatment after an accident.
8.5 Conservative return to work after an accident.
8.6 Systematic monitoring.
8.7 Recordability criteria. The accident must be work related. Simply stated, unless the
illness was caused solely by a non-work-related event or exposure off-premises, the
case is presumed to be work related.
8.8 Occupational injuries. Injuries are caused by instantaneous events in the work
environment. To keep recordkeeping determinations as simple and equitable as
possible, back cases are classified as injuries even though some back conditions may
be triggered by an instantaneous event and others develop as a result of repeated
trauma. Any occupational injury involving medical treatment, loss of consciousness,
restriction of work or motion, or transfer to another job is to be recorded on the
OSHA-300 form.
8.9 Periodic Workplace Walk-throughs. Health care providers will conduct periodic,
systematic workplace walk-throughs on a monthly basis (OSHA recommended) to
remain knowledgeable about operations and work practices, to identify potential light
duty jobs, and to maintain close contact with employees. Health care providers also
should be involved in identifying accident risk factors in the workplace as part of the
accident investigation team. A record will be kept documenting the date of the walkthrough, area(s) visited, accident risk factors recognized, and action initiated to
correct identified problems. Follow-up will be initiated and documented to ensure
corrective action is taken when indicated.
9. Accident trend analysis.
9.1 After an accident the accident investigation team will, where prudent, routinely
review health care facility sign-in logs, OSHA-300 forms, and individual employee
medical records to monitor trends for accidents in our facilities. This analysis should
be made to monitor trends and to substantiate the information obtained from the
accident investigation. The analysis will be done by department, job title, work area,
9.2 The information gathered will help to identify areas or jobs where potential accident
or injury conditions could or do exist. This information may be shared with anyone
in the company, since employees’ personal identifiers are not solicited. The analysis
of medical records (e.g., sign-in logs and individual employee medical records) may
reveal areas or jobs of concern, but it may also identify individual workers who
require further follow-up. The information gathered while analyzing medical records
will be of a confidential nature; thus care must be exercised to protect the individual
employee’s privacy.
9.3 The information gained from the trend analysis will help determine the effectiveness
of the various programs initiated to decrease accidents in our facility(s).
9.4 Employee survey. A survey may be used to provide a standardized measure of the
extent of progress in reducing work-related accidents for each area of the plant or
facility, and to determine which jobs are exhibiting problems and to measure progress
of the overall safety program.
Design of the survey. A survey of employees will be conducted to
measure employee awareness of work-related accident and to report the
location, frequency, and type of accidents likely to occur.
Surveys normally will not include employees’ personal identifiers, this is
to encourage employee participation in the survey.
Frequency. Surveys will be conducted as a minimum on an annual basis
or anytime deemed necessary by the accident investigation team.
Conducting the survey annually should help detect any major change in
the prevalence, incidence, and/or location of reported and unreported
9.5 Low risk jobs. This company will compile a list of light-duty jobs. Jobs will be
analyzed to determine the physical procedures used in the performance of each job,
including lifting requirements, postures, hand grips, and frequency of repetitive
motion and general safety requirements of the job. This information will assist health
care providers in recommending assignments to light or restricted duty jobs.
Supervisors should periodically review and update the lists.
Low Risk Job Listing
Date Evaluated
9.6 High risk jobs. This company will compile a list of high risk jobs. Jobs will be
analyzed to determine the physical procedures used in the performance of each job,
including lifting requirements, postures, hand grips, and frequency of repetitive
motion and general safety requirements of the job. This information will assist health
care providers in determining jobs from which assignments to light or restricted duty
jobs may be necessary. Supervisors should periodically review and update the lists.
High Risk Job Listing
Date Evaluated
10. Training and Education. The purpose of accident investigation training and education
is to ensure that members of the accident investigation team and all of our employees are
sufficiently informed about the accident investigation program.
10.1 Employees will be adequately trained about the (YOUR COMPANY)’s accident
investigation program. Proper training will allow managers, supervisors, and
employees to understand the procedures to follow to report an accident, hazards
associated with a job or production process, their prevention and control, and their
medical consequences.
10.2 Training program design. The program will be designed and implemented by
____________________________. Appropriate special training will be provided for
personnel responsible for administering the program.
10.3 Learning level. The program will be presented in language and at a level of
understanding appropriate for the individuals being trained. It will provide an
overview of the potential risk of illnesses and injuries, their causes and early
symptoms, the means of prevention, and treatment.
10.4 Training for affected employees will consist of both general and specific job
10.4.1 General Training. Employees will be given formal instruction on the
hazards associated with their jobs and with their equipment. This will
include information on the varieties of hazards associated with the job,
what risk factors cause or contribute to them, how to recognize and report
hazardous conditions, and how to prevent accident with their respective
jobs. This instruction will be repeated for each employee as necessary.
This training will be conducted on an annual basis. (OSHA’s experience
indicates that, at a minimum, annual retraining is advisable).
10.4.2 Job-Specific Training. New employees and reassigned workers will
receive an initial orientation and hands-on training prior to being placed in
a full-production job. Each new hire will receive a demonstration of the
proper use of and procedures for all tools and equipment prior to
10.5 Training for Supervisors. Supervisors are responsible for ensuring that employees
follow safe work practices and receive appropriate training to enable them to do this.
Supervisors therefore will undergo training comparable to that of the employees, and
such additional training as will enable them to recognize hazardous work practices, to
correct such practices, accident reporting/investigation requirements, and to reinforce
the ABC safety program.
10.6 Training for Managers. Managers will be made aware of their safety and health
responsibilities and will receive sufficient training pertaining to issues at each work
station and in the production process as a whole so that they can effectively carry out
their responsibilities.
10.7 Training for Engineers and Maintenance Personnel. Plant engineers and
maintenance personnel will be trained in the prevention and correction of job hazards
through job and work station design and proper maintenance, both in general and as
applied to the specific conditions of the facility.
10.8 Employee Training and Education. Company health care providers will
participate in the training and education of all employees. This training will be
reinforced during workplace walk-throughs and the individual health surveillance
appointments. All new employees will be given such education during orientation.
This demonstration of concern and the distribution of information should facilitate an
elimination or reduction in, and early recognition of accident conditions prior to their
development, and increase the likelihood of compliance with recognition, prevention
and control.
11. Behavior Modification and Attitude.
11.1 External causative or contributing factors. Behavior and attitude are integral to
the success of our accident investigation program. When accidents occur, the root
cause or causes may not always be external to the individual involved. These
external causes can include accidents within our facility(s) caused by:
Improperly maintained or defective machinery, equipment, tools, etc.
Coworker behavior and attitudes
Natural phenomenon such as lightening
Multiple causative situations
Lack of – or improper safety training
Operational or procedural inadequacies
11.2 Internal causative or contributing factors. When it is determined that it is
improbable that external factors were the principal cause(s) of an accident, behavior
and attitude of the individual or group or will be reviewed.
11.3 Affecting attitudinal and behavioral change. An employees’ attitude affects his or
her behavior. Improper behavior can sometimes result in an unsafe act. The unsafe
act can sometimes result in injury. Positive and proper attitudes toward safety are the
key to reducing unsafe acts and ultimately reducing injury rates. Creating an internal
change in individuals who otherwise would perform an unsafe act is the ultimate goal
when attempting attitudinal change. If an employee believes he or she has a safe
attitude but his or her behavior isn’t (or hasn’t in the past) been consistent with this
belief, the person will usually alter their behavior eventually to be consistent with
their self perception. An attitudinal change will occur which causes a behavioral
11.3.1 Creating attitudinal and behavioral change. This company is committed to
creat …
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