Supplemental Information for completing the Accident Investigation Report Note: Each accident will involve at least one of the following conditions as a contributing factor. Environmental Factors (Unsafe Conditions) Conditions Definition of Condition Suggested Corrective Action Unsafe procedures Hazardous Process. Management failed to make adequate for safety. A. Formulation of safe working procedures Improperly guarded Work areas, machines, or equipment that are unguarded or inadequately guarded. A. Inspection B. Checking plans, blueprints, purchase orders, contracts, and materials for safety C. Include guards in original design, order, and contract D. Provide guards for existing hazards Defective through use Buildings, machines, or equipment that have become rough, slippery, sharp edged, worn, cracked, broken, or otherwise defective through use or abuse. A. Inspection B. Proper Maintenance Defective through design Failure to provide for safety in the design, construction, and installation of buildings, machinery, and equipment. Too large, too small, not strong enough. A. Source of supply must be reliable B. Checking plans, blueprints, purchase orders, contracts, and materials for safety C. Correction of defects Unsafe clothing or personal protective equipment Management’s failure to provide or specify the use of goggles, respirators, safety shoes, hard hats, and other articles of safe dress or apparel. A. Provide safe apparel or personal protective equipment. B. Specify the use or non-use of certain apparel or protective equipment on certain jobs. Unsafe housekeeping facilities Unsuitable layout or lack of equipment necessary for good housekeeping (i.e. shelves, boxes, bins, aisle markers, etc.) A. Provide suitable layout and equipment necessary for good housekeeping. Improper ventilation Poorly or not ventilated area A. Improve ventilation Improper illumination Poorly or not illuminated area A. Improve illumination Behavioral Factors (Unsafe Acts) Factor Definition of Factor Suggested Corrective Action Lack of knowledge or skill Unaware of safe practice; Unskilled. Not properly instructed or trained. A. Job training B. Improved hiring practices Improper attitude A. Supervision B. Discipline C. Improved hiring practices Physical Deficiencies Worker has impaired eyesight or hearing, heart trouble, hernia, previous injuries, etc. A. Pre-employment physicals B. Periodic physicals C. Proper placement of workers D. Identification of workers with temporary physical deficiencies Substance Abuse Worker was the influence of (illegal or prescribed) drugs or alcohol while completing task A. Drug-Free Workplace Policy with drug/alcohol testing B. Discipline C. Rehabilitation
ENERGY SOURCE DETERMINATION CHECKLIST (Page 3) f. Thermal Energy? Yes No N/A If yes, location of main control/shut-off Can control/shut-off valve be locked in the “OFF” or closed position? Yes No If no, location of closest manual shut-off Does manual shut-off valve have a lock valve? Yes No Is there a bleed or drain valve to safely reduce system pressure and temperature and drain system chemicals? Yes No If no, how can the system be drained and neutralized? What personal protective clothing or equipment is needed for this equipment? Special precautions not noted above (i.e. fire hazards, chemical reactions, required cool down periods, etc.): Recommendations or Comments: Completed by: Reviewed by: Approved by:
Personnel — training, experience, methods of checking machines before use, type clothing, personal protective equipment, use of guards, tool storage, work practices, method of cleaning, oiling, or adjusting machinery. Kitchen Equipment — purchasing standards, inspection, storage, repair, types, maintenance, grounding, use and handling. Chemicals — storage, handling, transportation, spills, disposals, amounts used, toxicity or harmful effects, warning signs, supervision, training, protective clothing and equipment. Fire Prevention — extinguishers, alarms, sprinklers, smoking rules, exits, personnel assigned, separation of flammable materials and dangerous operations, waste disposal. Maintenance — regularity, effectiveness, training of personnel, materials and equipment used, records maintained, method of locking out machinery, general methods. Personal Protective Equipment — type, size, maintenance, repair, storage, assignment of responsibility, purchasing methods, standards observed, training in care and use, rules of use, method of assignment.
ILLINOIS RESOURCES FOR SAFETY AND HEALTH INFORMATION Iowa/Illinois Safety Council 8013 Douglas Avenue Urbandale, IA 50322-4724 (515) 276-4724 . (708) 544-2082 Professor & Extension Safety Specialist Dr. Robert Aherin Agricultural Engineering Sciences Building 360R AESB, MC-644 Ph: (217) 333-9417 Fax:(217) 244-0323 Dept. of Commerce & Economic Industrial Services Division – 400 (312) 814-2337 (Provides free OSHA safety & health consultation) (Click on “Resources) Manufacturers’ Association Headquarters (630) 368-5300 (800) 482-0462 (Regulatory & Compliance Information) Network for Agriculture Safety & Health Chip Petrea Agr & Bio Engineering Urbana, IL 61801 (217) 333-5035 Occupational & Environmental Health & The of at 2121 W. (312) 996-7887 National Safety Council (630) 285-1121 (800) 621-7619 National Safety Council (202) 293-2270 OSHA www.osha.gov Regional Office Room 3244 (312) 353-2220 State Offices OSHA – Area Office – (708) 891-3800 OSHA – Area Office – Des Plaines, IL 60016 (847) 803-4800 OSHA – Area Office 365 (630) 896-8700 OSHA – Area Office 2918 (309) 671-7033
RESOURCES FOR SAFETY AND HEALTH INFORMATION Extension Safety Specialist/Safety Specialist David Baker 2-28 Ag Building Columbia, Missouri 65211 (573) 882-6385 Missouri Department of Labor & Industrial Relations 3315 W. Truman Boulevard, Room 213 (573) 751-4091 Missouri On Site Consultation Program Robert Simmons, Program Mgr. – Department of & Standards (573) 751-3403 (Provides free OSHA safety & health consultation) OSHA Regional Office (816) 426-5861 State Offices Area Office (816) 483-9531 Toll Free { Residents Only}: (800) 892-2674 Area Office , Room 420 (314) 425-4249 Toll Free { Residents Only}: (800) 392-7743 National Safety Council Itasca, Il 60143-3201 (630) 285-1121 (800) 621-7619 Safety & Health Council of Western Missouri & (816) 842-5223 Safety Council of the Ozarks 1111 (417) 869-2121 Safety Council 118 S. 5th, Level (816) 233-3330 Safety Council of Greater (314) 621-9200 University of Missouri Extension
RESOURCES FOR SAFETY AND HEALTH INFORMATION Safety & Environmental Health Auxiliary Services Bldg (701) 777-3341 Workforce Safety & Insurance 1600 E. Century Avenue, (701) 328-3800 (800) 777-5033 North Dakota Department of Health Injury Prevention & Control 2nd Floor – Judicial Wing 600 E. Blvd. Avenue, Dept 301 -02200 (701) 328-4536 Safety Council (701) 223-6372 (800) 932-8890 Occupational Safety & Health Albert Koch Consultation – College Corporate & Continuing Education . (701) 224-5778 (Provides free OSHA safety & health consultation) National Safety Council (630) 285-1121 (800) 621-7619 OSHA Regional Office 1999 Broadway, (720) 264-6550 Office Area Office (701) 250-4521
RESOURCES FOR SAFETY AND HEALTH INFORMATION Safety Council 1108 NW Avenue 605-361-7785 or 1-800-952-5539 Division of Labor & Management (605) 773-3681 Engineering Extension Manning, Department Head 118, . (605) 688-4101 (Provides free OSHA safety & health consultation) National Safety Council (630) 285-1121 (800) 621-7619 OSHA Regional Office 1999 Broadway, (720) 264-6550 NO Area office in Contact Regional Office
RESOURCES FOR SAFETY AND HEALTH INFORMATION & 460 (608) 262-6330 www.wiscash.uwex.edu (608) 258-3400 (800) 236-3400 OSHA State Laboratory of Hygiene Environmental Health Division 2601 Agricultural (608) 226-5240 (Provides free OSHA safety & health consultation) Division of Marketing, Advocacy & Tech Development (262) 512-5198 or (800) 947-0553 (Provides free OSHA safety & health consultation) Cheryl Skjolaas 460 Henry Mall (608) 265-0568 Farm Worker Health and Safety National Safety Council Itasca, Il 60143-3201 (630) 285-1121 (800) 621-7619 OSHA (816) 426-5861 Area Office (920) 734-4521 Eau Claire Area Office 1310 W. Clairemont Avenue Eau Claire, WI 54701 (715) 832-9019 Madison Area Office 4802 E. Broadway (608)441-5388 Area Office , (414) 297-3315