Professional Documents
Culture Documents
Northwestern University Vice President for Research University Safety Committees Office for Research Safety
Hint: Save this file to your computer, complete your section, email a copy to the next person for their
part, and when all information has been entered, printed, and signed by the Principal Investigator, return
it to Tech, NG-71 .
7:30 am_____
I was washing a volumetric flask. I added a mixture of acid (hydrochloric and nitric) to the flask, a
procedure typical in our lab. I was holding the flask and swirling the acid along the inner walls.
2. Describe the incident in detail. What happened?
A reaction occurred inside the flask. I had capped it to prevent spillage. A pressure build-up blew the cap
off the flask and sprayed acid on my face. In shock, I dropped the flask on the bench and it shattered,
spilling acid on the surface.
3. Describe the sequence of events that followed the incident. How did you respond?
I ran to the eyewash at the sink and rinsed my face for approx. 15 minutes, holding my eyes open with my
hands. I called UP and requested emergency assistance. Paramedics arrived about 10 minutes after that.
4. Describe any equipment, machinery, or instruments in use at the time of the incident and their potential
contribution to the incident.
No equipment involved.
B. Did you sustain any injuries? What were they? How were they treated? Did you require medical
care? Describe the severity of the injury.
Limited burns to my face on my forehead and eyelids. I was taken to the emergency room where my face was
rinsed again and treated with topical antibiotic cream. I will have to avoid sunlight for a week since I sustained a
second-degree burn.
I was wearing a lab coat and nitrile gloves but no eye protection. I should have
been wearing safety glasses.
2. What type of training did you receive prior to engaging in this operation? Was the training adequate? What
did it consist of?
I received ORS general safety training when I entered the program my first year. No training since then.
Also, no training in my lab as to specific procedures. I believe I should have annual refresher training.
3. Are there any specific safety rules which apply to this procedure? Were they followed? Are they adequate?
No specific rules established for cleaning of glassware. There are rules regarding
PPE. Safety glasses are required and I will wear them from now on.
4. Other comments.
I was working alone in the lab. I wont do that again since I could have used help
in locating the eyewash.
E. Causal Factors
1. What do you perceive to be the causal factors behind this incident? This could include: inadequate management
oversight; lack of appropriate safety policy; proper equipment not used, required, or supplied; etc.
Position_____________________ _
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A. Description of Incident Where were you and what were you doing when
the incident occurred? What did you see?
Position_____________________ _
A. Description of Incident Where were you and what were you doing when
the incident occurred? What did you see?
B. Additional comments or observations.
E. Comments
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The student was working an 11-hour day. Fatigue may have been a factor. Workdays will be limited to 10 hours at the
most.
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An incident report needs to include all the essential information about the accident or near-miss. The reportwriting process begins with fact finding and ends with recommendations for preventing future accidents.
You may use a special incident reporting form, and it might be quite extensive. But writing any incident report
involves four basic steps, and those are the focus of todays post.
1. Find the Facts
To prepare for writing an accident report, you have to gather and record all the facts. For example:
Date, time, and specific location of incident
Names, job titles, and department of employees involved and immediate supervisor(s)
Names and accounts of witnesses
Events leading up to incident
Exactly what employee was doing at the moment of the accident
Environmental conditions (e.g. slippery floor, inadequate lighting, noise, etc.)
Circumstances (including tasks, equipment, tools, materials, PPE, etc.)
Specific injuries (including part(s) of body injured and nature and extent of injuries)
Type of treatment for injuries
Damage to equipment, materials, etc.
2. Determine the Sequence
Based on the facts, you should be able to determine the sequence of events. In your report, describe this sequence
in detail, including:
Events leading up to the incident. Was the employee walking, running, bending over, squatting, climbing,
lifting operating machinery, pushing a broom, turning a valve, using a tool, handling hazardous materials, etc.?
Events involved in the incident. Was the employee struck by an object or caught in/on/between objects?
Did the worker fall on the same level or from a height? Did the employee inhale hazardous vapors or get splashed
with a hazardous chemical?
Events immediately following the incident. What did the employee do: Grab a knee? Start limping? Hold
his/her arm? Complain about back pain? Put a hand over a bleeding wound? Also describe how other co-workers
responded. Did they call for help, administer first aid, shut down equipment, move the victim, etc.?
The incident should be described on the report in sufficient detail that any reader can clearly picture what
happened. You might consider creating a diagram to show, in a simple and visually effective manner, the
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sequence of events related to the incident and include this in your incident report. You might also wish to include
photos of the accident scene, which may help readers follow the sequence of events.
3. Analyze
Your report should include an in-depth analysis of the causes of the accident. Causes include:
Primary cause (e.g., a spill on the floor that caused a slip and fall)
Secondary causes (e.g., employee not wearing appropriate work shoes or carrying a stack of material that
blocked vision)
Other contributing factors (e.g., burned out light bulb in the area).
4. Recommend
Recommendations for corrective action might include immediate corrective action as well as long-term corrective
actions such as:
Employee training on safe work practices
Preventive maintenance activities that keep equipment in good operating condition
Evaluation of job procedures with a recommendation for changes
Conducting a job hazard analysis to evaluate the task for any other hazards and then train employees on these
hazards
Engineering changes that make the task safer or administrative changes that might include changing the way
the task is performed
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