Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

1 

DLA-SM ACCIDENT REPORTING & INVESTIGATING PROGRAM

Sep 2022 

PURPOSE

The purpose of this program is to establish a procedure for DLA-SM employees to report work 

related injuries and illnesses promptly and accurately.

RESPOSIBILITIES

DLA-SM Depot Managers must: 

Ensure all mishaps and near misses are reported and investigated in detail to determine all factors 

contributing to the event and document in ESAMS (Enterprise Safety Applications Management 

System) within established timelines.

Ensure corrective/preventive measures to prevent future occurrences are completed, 

implemented, and documented. 

Document that employees were briefed, corrective actions (interim and permanent) completed, 

status updates on actions completed, and request closure of ESAMS reports by the DLA-SM 

Safety Manager once all corrective actions are complete.

DLA-SM Safety Manager is responsible for: 

Providing Depot Managers technical guidance when establishing mishap and near miss 

reporting, investigating, and recordkeeping local standard operating procedures. Local SOPs will 

include guidance on the responsibility to coordinate and maintain mishap records following 

OSHA recordkeeping requirements. 

Sending DLA-SM annual self-assessment of the DLA-SM Depot facilities to the DLA-HQ OSH 

Office by the last workday in March each calendar year.

Providing Depot Managers technical guidance as they conduct mishap or near miss 

investigations, as they complete the DLA Form 7015 documenting all factors contributing to the 

work-related event, and when determining lessons learned. 

Ensuring the investigation results with all contributing factors and lessons learned are 

documented on the mishap or near miss report in ESAMS. Ensure DLA Form 7015 is complete 

and attached to the ESAMS report. Issue an ESAMS deficiency notice to address each factor 

contributing to the work-related event. 

Closing completed ESAMS deficiency notices. 

Sharing lessons learned with applicable personnel at the Depots as appropriate.

DLA-SM employees will: 

Follow the DLA-SM ESOHMS Program requirements to ensure their actions do not create 

hazards in the workplace that contribute to or result in a mishap or near miss event. 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

2 

Report unintended accidents/mishaps to the Depot Manager immediately. 

Report near misses immediately using one of the following methods: 

1. Verbally notify the Depot Manager. 

2. Submit a DLA Form 1404, “Hazard Near Miss Report.” 

3. Submit a Near Miss Report in ESAMS. 

ACCIDENT REPORTING PROCEDURES

Reporting and documenting DLA-SM work-related mishaps and near misses is detail and time 

critical. Concerning all mishap classes, the Depot Manager of the employee involved in a workrelated event documents the mishap in ESAMS (Enterprise Safety Applications Management 

System) within one workday of being informed the event occurred. 

The Depot Manager can use DLA Form 1404, “Hazard Near Miss Report” to document hazards 

and near misses. The DLA Form 1404 is an optional reporting method available for employee 

use in addition to using ESAMS. 

When reporting unintended incidences, and with assistance from DLA-SM Safety Manager or 

ESOH personnel, the Depot Manager will investigate the event and put controls in place to 

protect employees from hazards. 

The Depot Manager will document the event investigation in ESAMS within one working day of 

receiving information that an unintended work-related incident (injury, illness, property damage, 

fatality, and near miss) occurred. This allows for correction of hazards as soon as possible and 

accurate tracking of hazard trends. The investigation results must answer the five “Why” 

questions (See Appendix A of this document or Enclosure 4 of DLAM 6055.01 V1 referenced in 

this document) and identify ways to prevent future incidents. 

The Depot Manager will use DLA Form 1591 “Supervisor Mishap Report” to document mishaps 

when ESAMS is not available. Forward the completed form to the Safety Manager within one 

workday of the mishap occurrence. The Safety Manager will enter the DLA Form 1591 

“Supervisory Mishap Report” within one workday of ESAMS accessibility and destroys the 

paper hardcopy. 

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will use 

DoD Form 2977 “Deliberate Risk Assessment Worksheet” as the primary method to document 

risk assessments for all DLA operations and ensure risk is accepted at the appropriate level.

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will 

review DoD Form 2977 after a work-related mishap or near miss occurs and document the 

review in Block 13 “Risk Assessment Review” of the form. Block 13 “Risk Assessment 

Review” of DD Form 2977 is to be used to document a review of the incident/occurrence (e.g. 

after a mishap, near miss, etc.).

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will 

review the DLA Form 7001 (Job Hazard Analysis) after a work-related mishap or near miss and 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

3

document the review using the DLA Form 7001A. This will help support the risk management 

process in the workplace.

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will 

ensure the current DLA Form 7001 and DD Form 2977 are posted in the workplace and easily 

accessible to employees.

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will 

document all factors contributing to the mishap or near miss event. Provide the completed form 

to the Safety Manager.

With assistance from DLA-SM Safety Manager or ESOH personnel, the Depot Manager will 

respond to ESAMS deficiency notices and update ESAMS records with appropriate and accurate 

data- briefing employees on hazards identified, controls (interim and permanent) put in place, 

and document all actions completed on the deficiency notice in ESAMS. Document bi-weekly 

status updates in ESAMS on the deficiency notice through completion of corrective actions. 

Request closure of the deficiency notice.

The Depot Manager also completes the DLA Form 7015 “Mishap and Near Miss Analysis” and 

provides the completed copy to the DLA-SM Safety Manager to attach to the report in ESAMS. 

Concerning near miss incidents, the Depot Manager will document a near miss within one 

working day of being informed the event occurred and document investigation results and 

corrective actions taken in ESAMS. The Depot Manager also completes a DLA Form 7015 and 

provides it to the Safety Manager to attach the form to the report in ESAMS. The investigation 

results will provide information on the severity of injury, interim controls put in place, etc., 

answering the five “Why” questions provided in Appendix A (Root Cause Analysis Procedure) 

of this document or in Enclosure 4, Section 4 of DLAM 6055.01 V1. 

Depot Managers are to post OSHA Form 300A, “Summary of Work-Related Injuries and 

Illnesses” in the workplace readily accessible to DLA employees each year from February 1 

through April 30.

A DLA-SM employee may use ESAMS or complete a DLA Form 1404 “Hazard Near Miss 

Report”. ESAMS and the DLA Form 1404 provide the employee the opportunity to report the 

event anonymously. The DLA-SM Depot Manager or Safety Manager enters the information 

into ESAMS within three working days of receiving the form.
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

4 

Determining if an incident is considered a mishap or a near miss: 

DLA document reference: 

DLAM 6055.01-V1 - Enclosure 4: DLA Mishap and Near Miss Reporting and Safety

Investigation Procedures 

ACCIDENT INVESTIGATION PROCEDURES

The DLA-SM Depot Manager, with assistance from the DLA-SM Safety Manager or ESOH 

personnel, conducts a safety investigation for work-related mishaps and near misses. 

Investigation results and corrective actions are to be included in the ESAMS report. Near miss 

investigations are the most important investigations since no harm came to an employee. 

Examining a near miss is an opportunity to correct causes before an injury or property damage 

happens. 

Mishap/Near Miss Investigation procedure

DLA-SM Depot Managers and/or Safety Manager shall:

1. Immediately address any medical issues as appropriate and ensure that the area the 

incident occurred is adequately protected and safe.

2. Report the incident to the appropriate DLA-SM Materials Management/DLA 

Management as soon as possible, but no more than twenty-four (24) hours after it’s 

occurrence by fax, phone, or e-mail.

3. Begin the initial investigation by gathering the basic facts. 

4. Enter any gathered facts into ESAMS or complete within one (1) working day. (The 

DLA 1591 form can be used as a tool to document gathered facts prior to being 

entered into ESAMS or if ESAMS is not operational.) 

Did an event occur resulting 

in death, injury, illness,

or property damage?

YES

NO

Not a Mishap.

Was the outcome of the event 

intended?

NO

YES

Mishap Occurred.
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

5 

5. Institute any interim controls for deficiencies identified. 

6. Verify all long-term controls are instituted as required. 

7. ESOH personnel shall participate in the initial investigation as appropriate.

8. Investigate all mishaps/near misses utilizing the Root Cause Analysis Procedure and 

form (Appendix A) and determine the root cause(s).

9. Identify and document any deficiencies, appropriate corrective actions, lessons 

learned, etc.

10. Verify that interim controls are adequate and instituted for any identified deficiencies.

11. Document final outcomes utilizing the Root Cause Analysis form (Appendix A) and 

upload the completed form to ESAMS record. 

12. Finalize the input of required information into ESAMS including, but not limited to, 

ensuring a notation is entered documenting that any restrictions have been met, 

medical documentation is uploaded, etc.

13. Ensure the completed investigation report is routed for review by Materials 

Management personnel and concurrence. 

14. In the event of non-concurrence, ensure all issues raised are addressed and the report 

is re-routed for concurrence. 

All mishap/near miss safety incidence investigations shall be handled as a search for facts and 

must not be used to determine personal fault, nor shall the information obtained be used against 

an employee to invoke disciplinary action. 

The purpose of mishap and near miss safety investigations is to prevent future mishaps. Work 

related mishap classifications are determined both by the severity of injury and/or property 

damage caused by the mishap and the cost associated with that mishap.

All mishap/near miss investigation findings/root causes will be completed and recorded in 

ESAMS by the Depot Manager or Safety Manager within six (6) calendar days after the mishap 

date. The investigation results will provide information on the severity of injury, interim or 

permanent controls put in place, etc. ensuring to answer the five “Why” questions provided 

either as The Root Cause Analysis Procedure in Appendix A of this document or in Enclosure 4, 

Section 4 of DLAM 6055.01 V1. 

Work related mishap classes: 

1. Class A: Death, permanent total disabling injury or illness, property damage equal to or 

greater than $2.5 million. 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

6 

2. Class B: Permanent partial disabling injury (including loss of an eye or amputation) or 

illness, inpatient hospitalization of 1 or more individuals, or property damage equal to or 

greater than $600,000 but less than $2.5 million. Incorporates one inpatient 

hospitalization to align with the current OSHA requirements.

3. Class C: A recordable non-fatal injury or illness resulting in 1 or more days away from 

work, not including the day of the injury or property damage equal to or greater than 

$60,000 but less than $600,000. 

4. Class D: Property damage equal to or greater than $25,000 but less than $60,000; or an 

injury or illness including first aid not classified as a Class A, B, or C mishap.

Work related mishaps or near misses not meeting DoD thresholds: 

1. Class E: Property damage less than $25,000 or injury without first aid. 

2. Near Miss: No property damage and no personal injury, but damage and/or injury could 

have occurred given a slight shift in time or position. 

The explanation above is formatted into an easy-to-use diagram in the mishap and near miss 

classification determination table below. 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

7 

Assigning Mishap Classes to work-related mishap or near miss: 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

8 

For detailed work-related mishap and near miss safety investigation procedures, see DLAM 

6055.01 V1 Enclosure 4, Appendix A and Appendix B. All DLAM 6055.01 V1 Enclosures are 

listed below for easy reference on what each Enclosure addresses.

DLAM 6055.01-V1 - Enclosure 3: Investigations

DLAM 6055.01-V1 - Enclosure 4: DLA Mishap and Near Miss Reporting and Safety

Investigation Procedures 

DLAM 6055.01-V1 - Enclosure 4: Appendix A Work Related Mishap Class C, Class D, Class E, 

and Near Miss Safety Investigation Procedures 

DLAM 6055.01-V1 - Enclosure 4: Appendix B Work Related DLA Mishap Class A and Class B 

Safety Investigation Procedures

DLAM 6055.01-V1 - Enclosure 4: Appendix C Procedures for Recording Injury Costs

Associated With a Mishap

DLAM 6055.01-V1 - Enclosure 4: Appendix D Human Factors and Classification System

(HFACS)

DLAM 6055.01-V1 - Enclosure 4: Appendix E Sample Interview Statement

DLAM 6055.01-V1 - Enclosure 5: Privileged Safety Information

DLAM 6055.01-V1 - Enclosure 6: Data and Record Keeping Requirements 

DLAM 6055.01-V1 - Enclosure 7: Mishap Notification Investigation and Reporting Procedures 

DLAM 6055.01-V1 - Enclosure 8: Requirements for Safety Investigation Reports 

DLAM 6055.01-V1 - Enclosure 9: Information Cross-Feed Requirements

INJURY/MEDICAL ISSUES

Injuries/illnesses that require the employee to be compensated must be reported to the 

appropriate Injury Compensation Center (ICC) by the employee or the Depot Manager within 

thirty (30) days of the mishap date. For additional information, contact the DLA Human 

Resources division.

RECORDKEEPING

The DLA-SM Safety Manager will be maintaining the OSHA 300 Log in ESAMS and providing 

the OSHA 300A Log to the Depot Managers for public posting at their respective Depot facility, 

as required, each year from February 1 through April 30. 

Mishap reports shall remain active in ESAMS for the length of service of the employee and then 

archived.
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

9 

TRAINING

The DLA-SM Depot Manager, Safety Manager, and/or ESOH (Environmental, Safety, & 

Occupational Health) personnel will provide training to all DLA-SM Depot employees on the 

mishap and near miss reporting and investigation procedures annually.

Training will consist of the procedure for employees on reporting near misses or hazardous 

conditions through ESAMS or DLA form 1404 “Hazard Near Miss Report”, and reporting any 

mishaps to the Depot Manager; Depot Manager reporting of mishaps or near misses in ESAMS

and DLA form 1591 “Supervisory Mishap Report”, if ESAMS is unavailable; JHAs; mishap 

classes; site location where the OSHA form 300A is posted for public viewing; and the 

highlights of conducting reporting and investigating mishaps and near misses within the DLA 

workplace in accordance with the DLAM 6055.01 V1 manual standard procedures and the 

contents of this program document. 

REFERENCES

Occupational Safety & Health Administration (OSHA) 29 CFR 1904 Recording and Reporting 

Occupational Injuries and Illness

DLAI 6055.01 Safety and Occupational Health (SOH) Program, 2018 

DLAM 6055.01-V1 Mishap and Near Miss Notification, Investigation, Reporting, and Record 

Keeping, 2020 

DLAM 6055.01-V2 Safety and Occupational Health (SOH) Inspection and Hazard Management, 

2020 

DLAM 6055.01-V3 Safety and Occupational Health (SOH) Training and Awareness, 2020 
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

10

APPENDIX A

ROOT CAUSE ANALYSIS PROCEDURE

May 2022 

PURPOSE

To establish the procedure for a structured approach to conducting a root cause analysis for 

ESOH (Environmental, Safety, & Occupational Health) findings. The goals of the procedure are 

to identify: 

(1) the underlying factors of identified problems, 

(2) what needs to be changed to prevent the recurrence of these outcomes, and 

(3) the techniques required to promote the achievement of fewer consequences in the future.

PROCESS

Responsibility and Authority

The Environment, Safety, and Occupational Health (ESOH) Management 

personnel/representative (rep) have/has the primary responsibility and authority to monitor the 

ESOH Management System (ESOHMS) and are authorized to take necessary actions to assist the 

Depot Manager and Safety Manager to resolve identified nonconformance issues. The primary 

responsibilities of Depot Managers include investigating findings, implementing corrective and 

preventive actions, and maintaining documentation.

Assessing and Documenting Root Causes 

Once an ESOH incident/event has been identified, the root cause process may be initiated as 

described below: 

a. ESOH personnel will conduct the analysis and complete the attached Root Cause 

form. 

i. The form is based on the “Five Whys” technique. The “Five Whys” is a 

quick and easy analysis method 

to identify the root cause of a 

problem or variation. 

ii. This technique involves asking 

“why” up to five times to 

determine the root cause: 

1. Ask “why” the problem 

happens and write the 

answer down below the 

problem 

“Five Whys” Example

(1) Why did you have a 

noncompliance? Because the 

sample was not taken.

(2) Why wasn’t the sample taken? 

Because the designated person 

was out sick.

(3) Why didn’t someone else take the 

sample? Because no one else knew 

how.

(4) Why didn’t someone else know 

how? Inadequately roles and

responsibilities.

Root Cause: Because the procedure did 

not designate a backup
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

11

2. Ask “why” the previous answer happened and write that answer 

down 

3. Continue asking “why” for the previous answer until the problem's 

root cause is identified (may take fewer or more times than five 

whys)

4. This technique is also applied to the review of equipment 

malfunction or failures that may also cause or contribute to 

mishaps/near misses and conformance/compliance complications 

with ESOH provisions. Typical root cause results are as follows:

Equipment failure

Maintenance

Operation related

Power failure

System shutdown

System startup

System upset

Third-party damage

Under investigation

Weather related

Improper training

Inadequate procedure

Inadequate roles and responsibilities

iii. The ESOH rep is to document this process in the Root Cause form. 

iv. If the ESOH rep believes that the root cause can be determined with fewer 

than five questions, skip to the Root Cause cell of the form. Additional 

root causes can be added as determined by the ESOH rep.

b. If there is a likelihood that the adverse finding may recur, the ESOH rep shall 

recommend a preventive action, which is indicated on the form, otherwise mark 

“N/A”. 

c. Once the ESOH rep has completed the Root Cause form, it shall be forwarded to 

the Safety Manager for approval. 

i. The Safety Manager shall determine whether the analysis is appropriate or 

not and if the corrective/preventive action addresses the root cause. 

d. To approve the Root Cause Analysis, the Safety Manager signs the form, updates 

the ESAMS appropriately to indicate that the analysis has been completed, and 

attaches the completed Root Cause form to the ESAMS investigation report.
Hard copies of this document may not be the current version. Refer to the “I Am The Key” to

verify the current version.

12

DLA-SM ROOT CAUSE ANALYSIS FORM - FIVE WHYS TECHNIQUE

May 2022 

Incident: 

Date: 

ESOH Rep: 

Safety Manager: 

A. Why did the incident occur? 

B. Why did A. occur?

C. Why did B. occur?

D. Why did C. occur?

E. Why did D. occur?

 Root Cause:

Corrective/Preventive Action?

Example: There was only one 

qualifying rain event for sampling.

The designated sampler was out the 

day it rained.

No one else knew how to collect a 

sample.

No one else had been trained on the 

procedure.

No back-up sampler had been 

assigned.

Inadequate roles and responsibilities.