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Mine Accident

Cost-Compensation & Insurance

MANAK CHAND
JODHPUR
Manakchand.com@gmail.com
What is an accident
• An accident or a mishap is an incidental and
unplanned event or circumstance, often with lack of
intention or necessity. It usually implies a generally
negative outcome which might have been avoided
or prevented had circumstances leading up to the
accident been recognized, and acted upon, prior to
its occurrence.
What is an mining accident
• A mining accident is an accident that occurs during the
process of mining of minerals.
• Mining accidents can have a variety of causes,
including leaks of poisonous or explosive nature gases,
especially firedamp or methane, dust explosion,
collapsing of mine stopes, mining-induced seismity,
flooding, or general mechanical errors from improperly
used or malfunctioning mining equipment (such
as safety lamps or electrical equipment).
• Use of improper explosives underground can also
cause methane and coal dust explosions.
Mining Accident

Mount Mulligan mine disaster in Australia 1921, these cable


drums were blown 50 feet (15 m) from their foundations
following a coal dust explosion.
What Are the Most Common Accidents Occurring
in the Mining Industry?
• 1. Methane and Consecutive Coal Dust Explosions
• 2. Blasting Related Accidents
-Fly-Rocks:
-Premature Blast:
-Misfires
-Mine-Induced Seismicity
• Mine Inundation
• Roof Fall/Side Fall
• Mechanical Failures
• Mine Transport Accidents
• Human Errors
HAZARDS IN DIFFERENT OPERATIONS IN SURFACE MINES
• The major hazards due to different mining
operations are as outlined below:
• Fall from heights.
• Fall from vehicle.
• Falling from the edge of a bench.
• Entrapment of being struck by a moving and
revolving part of the drill equipment.
• Explosives
• Poorly designed shots can result in misfires
early ignition and flying rock.
• Face stability
• Rock fall or slide
• Loading
• Rock falling on the driver.
• Plant toppling aver due to uneven ground.
• Failure of hydraulic system.
• Fires
• VIII. Transporting
• Brake failure
• Lack of all-around visibility from driver position
• Vehicle movements particularly while reversing
• Rollover
• Vibrations
• Noise
• Dust and maintenance
• IX. Processing of mineral
• 1) Crushing
• Blockages
• High noise
• Dust
• Vibrations
• 2) Grinding
• Noise
• Dust
• Entrapment
• Confined spaces
• Chemical additives
• 3) Screening
• Dust
• Noise
• Vibration
• Fall from height during maintenance
• HAZARDS IN UNDERGROUND WORKING
• Fall of roof and sides
• Collapse of pillar in coal mines
• Rock burst and bumps
• Rope haulage
• Runaway of tubs due to breakage of rope, failure
of attachment to rope, failure of couplings and
drawbars.
• XI. Electrical hazards
• Electric shock and/or burn.
• Ignition of firedamp or coal dust.
• Fire arising from electric defects.
• Fire hazard
• Inundations
• Illumination
• Insufficient illumination system
• XIV. Ventilation
• Failing of cooling system.
• Oxygen deficiency (<19%)
• Gas evolution from coal
• Presence of CO > 50ppm
• Presence of CO2 > 1%
• Presence of H2S > 20ppm
• Presence of NOX
• Increase in temperature due to rock temperature
and heats from machines
Important causes of accidents
• Roof/side fall - accidental fall of roof or side at the
time of excavation - PRIMARY
• Winding - accident in the course of raising or lowering
coal or man in shaft
• Haulage - accident in the course of raising or lowering
coal by tubs -
• Dumper - accidents associated with dumper – wheeled
vehicles for carrying coal with tipper
mechanism
• Conveyer - accident in the use of belt or chain conveyers
• Other transport machinery - accident associated with
trucks and wagons
• Other machinery accident - associated with non-transport
machinery like loading machinery, crusher etc.
• Explosives - accident in the course of using
explosives
• Electricity - accidents resulting out of the use of
electricity
• Dust/gas - accidents due to explosions of noxious
gases, due to absence of oxygen, due to
explosion of coal dust etc.
• Fall of object/person - accidents occurring due to
sudden fall of an object or a
person
• Inundation - accidents due to sudden rushing in of
water
• Miscellaneous - other causes of accidents
Causes of Mine Accident
• Unsafe Act
• Unsafe conditions
• HUMAN FACTORS IN ACCIDENT
• Human factors are a major component of the causes of
accidents in the workplace. Estimates of the actual
extent of the involvement vary markedly, but a study of
the causes of all work-related fatalities occurring in
Australia over three years revealed that behavioural
factors were involved in more than 90% of fatal
accidents.
• In view of data like these, it is important to have an
understanding of the role of human factors in
accidents.
• A better understanding of how, why and when human
factors become involved in accidents enhances our
ability to make predictions about the role of human
factors and helps to prevent accidents.
• Mining accidents and disasters are
preventable. It is a tragedy that history is
often repeated and the lessons from previous
accidents and disasters seem to be forgotten
or ignored.
Accident Causation Theories
• The domino theory
• According to W.H. Heinrich (1931), who developed the so-called domino
theory, 88% of all accidents are caused by unsafe acts of people, 10% by
unsafe actions and 2% by “acts of God”. He proposed a “five-factor
accident sequence” in which each factor would actuate the next step in
the manner of toppling dominoes lined up in a row. The sequence of
accident factors is as follows:
• 1. ancestry and social environment
• 2. worker fault
• 3. unsafe act together with mechanical and physical hazard
• 4. accident
• 5. damage or injury.
• In the same way that the removal of a single domino in the row would
interrupt the sequence of toppling, Heinrich suggested that removal of
one of the factors would prevent the accident and resultant injury; with
the key domino to be removed from the sequence being number 3.
Although Heinrich provided no data for his theory, it nonetheless
represents a useful point to start discussion and a foundation for future
research.
• Multiple causation theory
• Multiple causation theory is an outgrowth of the domino theory, but it postulates
that for a single accident there may be many contributory factors, causes and sub-
causes, and that certain combinations of these give rise to accidents. According to
this theory, the contributory factors can be grouped into the following two
categories:
• Behavioural. This category includes factors pertaining to the worker, such as
improper attitude, lack of knowledge, lack of skills and inadequate physical and
mental condition.
• Environmental. This category includes improper guarding of other hazardous work
elements and degradation of equipment through use and unsafe procedures.
• The major contribution of this theory is to bring out the fact that rarely, if ever, is
an accident the result of a single cause or act.
• The pure chance theory
• According to the pure chance theory, every one of any given set of workers has an
equal chance of being involved in an accident. It further implies that there is no
single discernible pattern of events that leads to an accident. In this theory, all
accidents are treated as corresponding to Heinrich’s acts of God, and it is held that
there exist no interventions to prevent them.
• Biased liability theory
• Biased liability theory is based on the view that once a
worker is involved in an accident, the chances of the same
worker becoming involved in future accidents are either
increased or decreased as compared to the rest of workers.
This theory contributes very little, if anything at all, towards
developing preventive actions for avoiding accidents.
• Accident proneness theory
• Accident proneness theory maintains that within a given
set of workers, there exists a subset of workers who are
more liable to be involved in accidents. Researchers have
not been able to prove this theory conclusively because
most of the research work has been poorly conducted and
most of the findings are contradictory and inconclusive.
This theory is not generally accepted. It is felt that if indeed
this theory is supported by any empirical evidence at all, it
probably accounts for only a very low proportion of
accidents without any statistical significance.
• The energy transfer theory
• Those who accept the energy transfer
theory put forward the claim that a worker
incurs injury or equipment suffers damage
through a change of energy, and that for
every change of energy there is a source, a
path and a receiver. This theory is useful for
determining injury causation and evaluating
energy hazards and control methodology.
Strategies can be developed which are
either preventive, limiting or ameliorating
with respect to the energy transfer.
• The “symptoms versus causes” theory
• The “symptoms versus causes” theory is not so much a theory as an
admonition to be heeded if accident causation is to be understood.
Usually, when investigating accidents, we tend to fasten upon the
obvious causes of the accident to the neglect of the root causes.
Unsafe acts and unsafe conditions are the symptoms—the
proximate causes—and not the root causes of the accident.
• Structure of Accidents
• The belief that accidents are caused and can be prevented makes it
imperative for us to study those factors which are likely to favour
the occurrence of accidents. By studying such factors, the root
causes of accidents can be isolated and necessary steps can be
taken to prevent the recurrence of the accidents. These root causes
of accidents can be grouped as “immediate” and “contributing”.
The immediate causes are unsafe acts of the worker and unsafe
working conditions. The contributing causes could be management-
related factors, the environment and the physical and mental
condition of the worker. A combination of causes must converge in
order to result in an accident.
Cost of Accidents
Cost of Accidents
• How much an accident actually costs a
company?
• The cost of a workplace accident affects a
company’s bottom line.
• Accidents are more expensive than many of us
realize due to hidden costs.
Cost of Accidents

Cost of Accident may be –


• Direct costs
• Indirect costs
Cost of Accidents
• Accidents are more expensive than most
people realize because of the hidden costs.
Some costs are obvious — for example,
Workers' Compensation claims which cover
medical costs and indemnity payments for an
injured or ill worker. These are the direct
costs of accidents.
• Visible costs such as medical expenses, costs
to replace equipment, fines and penalties are
easy to find and calculate, but it is not easy to
find information necessary to calculate the
hidden costs not directly associated with the
accident, such as the cost to train and
compensate a new employee, investigate the
accident or implement corrective action.
Cost of Accidents
Direct and Indirect Accident
Costs
• A direct cost is a cost that can be easily and
conveniently traced to the accident such as
medical expenses and indemnity payments
while an indirect cost is a cost that cannot be
easily and conveniently traced to the
particular accident such as the salary of the
person investigating the accident.
• Direct costs of accidents
• Direct costs are those costs that are accrued
directly from the accident. They are quite easy
to calculate, and include the medical costs
incurred and the compensation payments
made to the injured workers. Direct costs are
usually insurable by businesses.
• Indirect costs
• Indirect costs are all the "uninsured" additional
costs associated with an accident. What is
important to realize is that indirect costs are
usually much greater than direct costs. Another
important point is that, unlike direct costs,
indirect costs are uninsured...they come right out
of the corporate pocketbook. These are the costs
that can drive a company into the red.
• Indirect costs are the less obvious
consequences of an accident that can be
costed. While the indirect costs created by
accidents are hidden, they too must be paid
from profits from the sale of products. They
are more difficult to calculate and tend not to
be insured.
The examples of indirect or uninsured costs:
• Lost production time.
• Productive time lost by an injured
employee. Productive time lost by employees
and supervisors helping the accident
victim. Cleanup and startup of operations
interrupted by an accident.
• Time to hire or train a worker to replace the
injured worker until they return to
work. Property damage.
• Time and cost for repair or replacement of
damaged equipment, materials or other
property. Cost of continuing all or part of the
employee's wages, plus compensation.
• Reduced morale among your employees, and
perhaps lower efficiency. Cost of completing
paperwork generated by the accident.
• Govt. penalties.
• Other indirect costs include such factors as a
surcharge on the company’s insurance premium.
Other costs may include civil or criminal penalties
imposed by state or federal officials if the
accident is found to have resulted from flagrant
violation of workplace safety requirements.
• Studies have shown that such indirect costs
usually total three to four times the direct costs
of the accident and could amount to as much as
20 times the direct costs.
Indirect costs also include:
• Time away from the job not covered by
workers' compensation insurance;
• Payment of other workers who are not
injured, for example those who stopped work
to look after or help the injured worker and
those who require output from the injured in
order to complete their tasks;
• The cost of damage to materials or equipment
involved in the accident;
• The cost of overtime imposed by the accident
(lost production, additional supervision, and
additional heat, light, etc.);
• The cost of wages paid to the supervisor for time
spent on activities related to the accident. This
includes caring for the injured, investigating the
accident and supervising the activities necessary
to resume the operation of business. All of these
activities will disrupt the supervisor's
productivity;
• Costs associated with instructing, training, and
repositioning employees in order to resume
production. In some cases, it might even be
necessary to hire a replacement with all the
associated hiring costs;
• Medical costs paid by the employer that are
not covered by the insurance. This may
include treatment facilities, personnel,
equipment and supplies;
• Cost of managers and clerical personnel
investigating and processing claim forms and
related paperwork, telephone calls,
interviews, etc.
• Wage costs due to decreased productivity
once the injured employee returns to work.
This is due to restricted movement or
nervousness/cautiousness on the part of the
injured employee and time spent discussing
the accident with other employees etc.
• Costs brought about from any enforcement
action following the accident such as prosecution
fines and costs of imposed remedial works.
• A series of costly accidents can reduce profits
radically. Accidents have obvious, direct costs
such as medical, hospital and rehabilitation
expenses, workers compensation payments, and
higher insurance premiums or even loss of
insurability.
• But, accidents have less obvious, indirect costs
that are usually uninsured. These include the
various disruptions to normal work
procedures, such as when employees stop to
help the injured employee, or even a drop in
production that cause inconsistencies with
delivery. If profits are not sufficient to cover
costs, the company may be forced to defer the
procurement of new equipment and facilities.
• Studies show more accidents that occur in a
workplace, the higher the costs — both in increased
insurance premiums and greater indirect costs.

Ratio of Indirect to Direct Costs


Financial and Lost Opportunity.
• Financial costs are costs a company must pay as a
result of an accident and may include overtime
payments, repair costs, cost of extra materials, fines,
and penalties.
• Lost opportunity costs include those costs associated
with labour paid for no production, such as salary costs
of employees waiting to work, employees at home
unable to work while injured, and costs for machinery
running idle.
• Lost opportunity costs also include production and
resource losses due to interruptions in the production
cycle, the inability to mine previously identified
mineral resources and reserves, and the delay of
converting mined material into revenue through sales
or other types of financial transactions.
HIDDEN COSTS OF ACCIDENTS
• An area of major concern to employers is the cost of
accidents. Many people do not realize
how much accidents really cost. In fact, many expenses
are not always obvious. Attention to
loss control can improve a company’s overall success.
• Where does the money come from to pay for the
results of accidents? Some people believe that
organizations have money set aside to pay for accident
costs. However, employers know that the money must
come from profits.
• People often try to minimize the costs of accidents by
saying that they are covered by insurance. Insurance,
however, covers only a portion of the total accident
cost. Moreover, as accident losses increase, so will a
company’s insurance premiums. It is clear that directly
and indirectly, accidents reduce profitability.
Total accident costs can be compared to an iceberg.
The part of the iceberg that can be seen above the
surface is like the smaller, direct portion of the total
accident costs. An examination of a serious accident
can give you a better understanding of what makes up
total accident costs.
• For example, an employee receives an electric
shock from faulty equipment and is seriously
injured. Many people in the department stop
working. Some rush to give first aid to the injured
person, while others call for help. When help
arrives for the injured employee, do employees
immediately return to work?
As soon as the injured person receives proper
medical treatment, your next job is to investigate
the accident. All time spent on accident
investigation and reporting as well as wages paid
to witnesses is included in the total accident
costs.
• If the injured person misses work for only a short time,
you may be able to make up for the production loss by
having the rest of the department work overtime.
• Overtime wages paid are included as total accident
costs.
• If the injured employee is gone for months, you may
have to hire and train a replacement worker. Typically
new employees are less efficient for a period.
• Damaged machinery may also reduce production as
you must make do with alternative
equipment while replacements or repairs are
complete. All this reduced efficiency represents
another indirect cost.
• Like an iceberg, the hidden costs of accidents are
not visible on the surface, but are still present.
Examples of such hidden costs:
• Production loss/worker distraction
• Training costs/replacement worker
• Loss of skill/efficiency - slowed production
• Paperwork
• Administrative time
• Loss of morale
• Legal issues
• Medical expenses
• Wages
• Equipment
• Workers compensation premium
• Just as there are many hidden costs due to accidents,
there are hidden savings in accident prevention. For
this reason, the phrase “loss control” is often used in
safety management. Every accident you prevent saves
direct and indirect accident costs - effecting your
bottom line. Other benefits of accident prevention
efforts include:
• Safe / uninjured employees.
• Property and materials will not be damaged.
• No disruption to production supervisors/managers
can focus efforts on other projects.
• Increased employee security at work.
• Examples of hidden costs can include:
- Damage to the vehicle or equipment the worker
was using at the time. This could require
expensive repair or replacement.
- Loss of the worker’s time. There may be loss of
time by fellow employees and supervisors
responding to the injury-causing incident, or
transporting the injured employee to the medical
facility.
- Temporarily lowered morale, efficiency, and
productivity by co-workers and supervisors.
- Cost of hiring and training a temporary or
permanent replacement for the injured employee,
with lower productivity during the hiring and
training process. Also the other fellow employees
that have to pick up the injured employees duties
while he is absent from work (3 employees doing
what takes 4 to do normally).
- The cost of Loss Control to investigate the
accident, and communicate with the insurance
company.
- The time it takes your supervisor to complete the
accident report and communicate with Loss
Control.
The unknown costs of an accident
• There are other costs that are difficult or impossible to
measure that may have a "fatal" impact on the success of
the company. These are unknown or unknowable costs of
workplace accidents: morale and reputation.
• When a serious accident or fatality occurs in the workplace,
a very basic, negative message may be sent to employees:
"management does not care." The message may be subtle,
but it may be there. In many instances employee morale
suffers, and this usually negatively impacts the quantity and
quality of the work they perform.
• Another factor that might affect the long-term success of
the company is that of reputation. The reputation of a
company is a reflection of its public image and must be
considered as an important factor influencing its success.
Accident Compensation & Insurance
• Many employers believe that the insurer will
pick up the costs of an accident, and that's
why they pay their insurance.
• People often try to minimize the costs of accidents by
saying that they are covered by insurance. Insurance,
however, covers only a portion of the total accident
cost. Moreover, as accident losses increase, so will a
company’s insurance premiums. It is clear that directly
and indirectly, accidents reduce profitability.

Total accident costs can be compared to an iceberg.


The part of the iceberg that can be seen above the
surface is like the smaller, direct portion of the total
accident costs. An examination of a serious accident
can give you a better understanding of what makes up
total accident costs.
• Disablement
Injury caused to a workman by an accident ordinarily results in
the loss of the earning capacity of the workman concerned and
this loss of earning capacity is technically "Disablement".
• Disablements can be classified as (a)Total and (b) Partial.
• It can further be classified Into (I) Permanent, And (Ii)
Temporary,
• Disablement, whether permanent or temporary is said to be
total when it incapacitates a worker for all work he was capable
of doing at the time of the accident resulting in such
disablement.
• "Total Disablement" is considered to be permanent if a
workman, as a result of an accident, suffers from the injury
specified in Part I of Schedule I or suffers from such
combination of injuries specified in Part II of Schedule I as
would be the loss of earning capacity when totaled to one
hundred per cent or more.
• Accident Compensation
1. The employer of any establishment covered under
this Act, is required to compensate an employee
2. (A) Who has suffered an accident arising out of and
in the course of his employment, resulting into
3. (I) Death, (Ii) Permanent Total Disablement, (Iii)
Permanent Partial Disablement, Or (Iv) Temporary
Disablement Whether Total Or Partial, Or
4. (B) Who Has Contracted An Occupational Disease.
Insurance Costs

• Employers Liability
• Public Liability
Uninsured Costs
• Product and material damage
• Lost production time
• Legal costs
• Overtime & temporary labour
• Investigation time/Administration
• Supervisors time
• Fines
• Loss of expertise/experience
• Loss of morale
• Bad publicity
Accident Costs Iceberg
Insurance Costs

Uninsured Costs
Accident Investigation & Reporting
Why Investigate ?

• Legal Requirement
• Establish Causes
• Prevent Recurrences
• Accurate record
(courts & enquiries)
• Statistical data base
Accident Investigation
• A systematic approach to accident investigation, the
identification of causal factors and implementation of
corrective actions is essential to a good H&S program and
management system. Good procedures:
– provide information needed to determine injury rates, identify
trends or problem areas, permit comparisons and satisfy Workers
Compensation requirements;
– identify, without placing blame, the basic causal factors that
contributed directly or indirectly to each accident;
– identify deficiencies in management systems;
– suggest corrective action alternatives for a given accident;
– suggest corrective action alternatives for the management system.
What, When & How to Investigate
• What to Investigate ? • Who should Investigate?
– all accidents & near misses – Supervisor ?
– as soon as possible – WH&S Officer?
– scene interference – WH&S Representative?
– survey of scene – Team?
– chronology of data
– measurements, maps &
• Training & Skills
sketches – investigative & recording skills
– eyewitnesses – technical knowledge
– reconstruction ? – interviewing skills
– statistics & trends – report writing skills
– injury types & groups
Tool Kit
• specimen containers
• clipboard, paper (incl graph)
pens • magnifying glass
• camera & spare films • compass
• tape measure • danger tags
• cassette recorder & spare tapes • yellow crayon
• reporting forms • orange flouro spray paint
• hi-viz barrier tape for scene • torch with batteries
preservation • hi-viz orange vest
• first aid kit • hearing & eye protection
• identification tags for parts • plastic containers for samples
• gloves (industrial & medical) • roll of paper towelling
• safety helmet
Let Us Begin !
• Take all necessary steps to provide
emergency rescue and medical help
for the injured; and
• take those actions that will prevent,
or minimise the risk of further
accidents or physical harm to the
victim or others
Action Plan
• Identification of the individual who is in charge and assigns
responsibilities;
• Authority to conduct investigation;
• Securing the accident site for the duration of the investigation,
after rescue and damage control are complete;
• Photographic support or capability;
• Procedures & equipment to ensure observation and recording
of fragile, perishable or transient evidence (instrument
readings, control panel settings, weather & other
environmental conditions, chemical spills, stains, skid marks);
• Development of a comprehensive report.
Determine the Facts

• Visit accident scene


• Take samples
• Visual records
• Preserve accident items
• Identify people involved
• Interview witnesses
• Review information
Finding Facts
(logic method)
• What was the exact injury or damage ?
• What was the damaging energy source ?
• What event immediately preceded the damaging event ?
• What happened before that ?
• What happened even before that ?
• What happened in between ?
• What else was going on at the time of the accident ?
• Was anyone else involved ?
• Interview witnesses
Interviewing Techniques
• Put at ease
• Assure “no blame”
• Ask witness to relate their
account of the accident
• Listen carefully
• Ask questions - reinforce
• Repeat if necessary
• Ask witness for suggestions for
future avoidance
• Encourage further contact
• Be polite and thank the witness
A Good Report
• Accuracy & completeness of information
• Clarity & completeness of of the description of
the sequence of events leading up to the
accident
• Correct identification of all causal factors
• Clarity & completeness of all causal factors “A
• Recommendations made for corrective actions GOOD
to reduce or eliminate the probability of REPORT”
recurrence of a similar accident
• Recommendations for corrective actions to
improve management system BY
• Timelines - specific time periods, monitoring CLEVER DICK
and responsibilities
• Proper review and sign off
Documentation
• Accident investigation Form
• Witness Statements & Records of
Interview
• Checklists:
– Victim(s)
– Witnesses
– Environment & Locations
– Equipment & Parts
– Documentation
• Accident/Incident Record
Records
• Specified forms
– records maintained
– periods
• Notifiable injury - S.B.I.
– admitted as an “in-patient”
• Times
– S.B.I. - within 24 hours
– death - immediately
Effects of Accidents

• 1. On the Victim
• 2. On the Supervisor
• 3. On the Company
• 4. On the Nation
1. The Victim
• Death
• Pain & suffering
• Permanent disability
• Effects on family & dependants
• Loss of earnings
• Extra expenditure
• Inability to resume occupation
• Psychological effects
• Feeling of uselessness
• Fear of further injury
• Social effects
• Loss of sports or hobby
2. The Supervisor
• loss of trained worker
• loss of production
• extra work
• investigations & reports
• training new employee
• loss of prestige by:
– management
– other workers
• effects on promotion
• worry (could I have prevented it ?)
• Stress
3. The Company
• loss of trained worker
• loss of production
• damage to machinery
• damage to equipment
• wasted materials
• increased insurance premiums
• prosecutions
• fines
• civil actions
• legal costs
• loss of prestige - customers
4. The Nation

• loss of section of workforce


• loss of production
• increased cost of production
• effects on imports
• effects on exports
• effects on balance of trade
• the community pays !
Prevention
• Effective Management & Supervision
• Commitment to Accident Prevention
• Effective Policy & Procedures
• Effective Reporting & Recording
• Regular Consultation & “Toolbox” Meetings
• Risk Assessments
• Specific Training
• Literature & Culture
• Incentive Schemes ?
Warning Signs
 Increases in breaches of safety procedures
 Increase in reportable incidents
 Technical concerns
 Friction or disputes
 ageing or suspect equipment
 Introduction of new procedures or equipment
 New employees
 Age of employees
 Long periods of work
 Environmental issues
Resources
• Safety Officers
• Bureau of Emergency Services
• Div Workplace Health & Safety
• Workers Compensation Board
• Queensland Health
• Doctors & Specialists
• Rehabilitation Experts
• Consultants
• Psychologists
• Employee Assistance Programs
The Investigation
Investigation Strategy
• Gather information
• Search for & establish facts
• Isolate essential contributing factors
• Find root causes
• Determine corrective actions
• Implement corrective actions
Secure the Scene
• Eliminate the hazards:
– Control chemicals
– De-energize
– De-pressurize
– Light it up
– Shore it up
– Ventilate
Provide Care to the Injured
• Ensure that medical care is provided to the
injured people before proceeding with the
investigation.
Isolate the Scene
• Barricade the area of the accident, and keep
everyone out!
• The only persons allowed inside the barricade
should be Rescue/EMS, law enforcement, and
investigators
• Protect the evidence until investigation is
complete
Ask “What Happened”

• Get a brief overview of


the situation from
witnesses and victims.
• Not a detailed report
yet, just enough to
understand the basics of
what happened.
Interview Victims & Witnesses

• Interview as soon as
possible after the incident
– Do not interrupt medical
care to interview
• Interview each person
separately
• Do not allow witnesses to
confer prior to interview
The Interview

• Put the person at ease.


– People may be reluctant to
discuss the incident,
particularly if they think
someone will get in trouble
• Reassure them that this is a
fact-finding process only.
– Remind them that these facts
will be used to prevent a
recurrence of the incident
The Interview
• Take Notes!
• Ask open-ended questions
– “What did you see?”
– “What happened?”
• Do not make suggestions
– If the person is stumbling over a word or concept,
do not help them out
The Interview
• Use closed-ended questions later to gain more
detail.
– After the person has provided their explanation,
these type of questions can be used to clarify
– “Where were you standing?”
– “What time did it happen?”
The Interview
• Don’t ask leading questions
– Bad: “Why was the forklift operator driving
recklessly?”
– Good: “How was the forklift operator driving?”
• If the witness begins to offer reasons, excuses,
or explanations, politely decline that
knowledge and remind them to stick with the
facts
The Interview
• Summarize what you have been told.
– Correct misunderstandings of the events between
you and the witness
• Ask the witness/victim for recommendations
to prevent recurrence
– These people will often have the best solutions to
the problem
The Interview

• Get a written, signed statement from the


witness
– It is best if the witness writes their own
statement; interview notes signed by the
witness may be used if the witness refuses to
write a statement
Interview Exercise
• Read the scenario handout
• Team up in pairs
• One person plays the investigator
• One person plays the witness
Gather Evidence
• Examine the accident scene. Look for things
that will help you understand what happened:
– Dents, cracks, scrapes, splits, etc. in equipment
– Tire tracks, footprints, etc.
– Spills or leaks
– Scattered or broken parts
– Etc.
Gather Evidence

• Diagram the scene


– Use blank paper or graph
paper. Mark the location of
all pertinent items;
equipment, parts, spills,
persons, etc.
– Note distances and sizes,
pressures and temperatures
– Note direction (mark north
on the map)
Gather Evidence

• Take photographs
– Photograph any items or scenes which may
provide an understanding of what happened to
anyone who was not there.
– Photograph any items which will not remain, or
which will be cleaned up (spills, tire tracks,
footprints, etc.)
– 35mm cameras, Polaroids, and video cameras are
all acceptable.
• Digital cameras are not recommended - digital
images can be easily altered
Review Records
• Check training records
– Was appropriate training provided?
– When was training provided?
• Check equipment maintenance records
– Is regular PM or service provided?
– Is there a recurring type of failure?
• Check accident records
– Have there been similar incidents or injuries
involving other employees?
ISOLATE FACT FROM FICTION
• Use NORMS-based analysis of
information
– Not an interpretation
– Observable
– Reliable
– Measurable
– Specific
• If an item meets all five of above, it is
a fact.
INVESTIGATION TRAPS
• Put your emotions aside!
– Don’t let your feelings interfere - stick
to the facts! (The Eyes Glazed Over)
• Do not pre-judge.
– Find out the what really happened.
– Do not let your beliefs cloud the
facts.
• Never assume anything.
• Do not make any judgements.
CONTRIBUTING FACTORS
• ENVIRONMENTAL

• DESIGN

• SYSTEMS & PROCEDURES

• HUMAN BEHAVIOR
CONTRIBUTING FACTORS
• HUMAN BEHAVIOR

– Common to all accidents


– Not limited to the person involved in the
accident
CONTRIBUTING FACTORS
• ENVIRONMENTAL
– Noise
– Vapors, fumes, dust
– Light
– Heat
– Critters
CONTRIBUTING FACTORS

• DESIGN
– Workplace layout
– Design of tools &
equipment
– Maintenance
CONTRIBUTING FACTORS
• SYSTEMS & PROCEDURES
– Lack of systems & procedures
– Inappropriate systems & procedures
– Training in procedures
– Housekeeping
CONTRIBUTING FACTORS
INVESTIGATION STRATEGY

• ISOLATE ESSENTIAL CONTRIBUTORY


FACTORS

– INVESTIGATION TEAM

• EVALUATES ALL FACTORS CONCERNED


CONTRIBUTING FACTORS
INVESTIGATION STRATEGY
• ISOLATE ESSENTIAL CONTRIBUTORY FACTORS

– INVESTIGATION TEAM

• ISOLATES THE KEY FACTOR(S) BY ASKING THE


FOLLOWING QUESTION....
CONTRIBUTING FACTORS
INVESTIGATION STRATEGY

WOULD THE ACCIDENT HAVE HAPPENED IF


THIS PARTICULAR FACTOR WAS NOT PRESENT?
DETERMINE CAUSES
• Employee actions
• Safe behavior, at-risk behavior
• Environmental conditions
• Lighting, heat/cold, moisture/humidity, dust, vapors, etc.
• Equipment condition
• Defective/operational, guards, leaks, broken parts, etc.
• Procedures
• Existing (or not), followed (or not), appropriate (or not)
• Training
• Was employee trained - when, by whom, documentation
FIND ROOT CAUSES

• When you have determined the


contributing factors, dig deeper!
– If employee error, what caused that
behavior?
– If defective machine, why wasn’t it
fixed?
– If poor lighting, why not corrected?
– If no training, why not?
PREPARE A REPORT
• Accident Reports should contain the
following:
– Description of incident and injuries
– Sequence of events
– Pertinent facts discovered during
investigation
– Conclusions of the investigator(s)
– Recommendations for correcting
problems
PREPARE A REPORT, CONT.
• Be objective!
– State facts.
– Assign cause(s), not blame.
– If referring to an individuals actions, don’t use
names in the recommendation.
• Good: All employees should…….
• Bad: George should……..
MAKE RECOMMENDATIONS

• DETERMINE CORRECTIVE ACTIONS

– INVESTIGATION TEAM

• INTERPRETS & DRAWS CONCLUSION


• DISTINCTION BETWEEN INTERMEDIATE & UNDERLYING
CAUSES
MAKE RECOMMENDATIONS

• DETERMINE CORRECTIVE ACTIONS


– INVESTIGATION TEAM

• Recommendations based on key contributory factors


and underlying/root causes
MAKE RECOMMENDATIONS

• IMPLEMENT CORRECTIVE ACTIONS


– INVESTIGATION TEAM
• Recommendation(s) must be communicated clearly and
objectively.
• Strict time table established
• Follow up conducted
COMPANY ACCIDENT FORMS

• Must be filled out completely by the


employee and employee’s immediate
supervisor (this includes foremen).
• Must be turned in to Safety within 24
hours of incident.
BENEFITS OF ACCIDENT
INVESTIGATION

• PREVENTING RECURRENCE

• IDENTIFYING OUT-MODED PROCEDURES

• IMPROVEMENTS TO WORK ENVIRONMENT


BENEFITS OF ACCIDENT
INVESTIGATION

• INCREASED PRODUCTIVITY

• IMPROVEMENT OF OPERATIONAL & SAFETY


PROCEDURES

• RAISES SAFETY AWARENESS LEVEL


BENEFITS OF ACCIDENT
INVESTIGATION

WHEN AN ORGANIZATION REACTS SWIFTLY


AND POSITIVELY TO ACCIDENTS AND INJURIES,
ITS ACTIONS REAFFIRM ITS COMMITMENT TO
THE SAFETY AND WELL-BEING OF ITS
EMPLOYEES
What Can Be Done to Prevent Mining Accidents?

• 1. Training Is Key
Compulsory Training Programs for Miners
Prevention Through Simulation
Blasting License
Administration Classes on Health, Safety, and Mining
Methods
• 2. Safety Legislation
• 3. Technology Standard
Personal Protective Equipments
Exploitation Infrastructure
Explosive Products
Thank you

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