PSM General Awareness Training by Gary Whitmore - HTML preview

Chapter 12 – Incident Investigations

It’s unfortunate, but incidents do occur.

Therefore, the employer shall investigate each incident, which resulted in, or could reasonably have resulted in a catastrophic release of highly hazardous chemical.

The incident investigation shall be initiated as promptly as possible, but not later than 48 hours following the incident.

Incident investigation team shall consist of:

• One person knowledgeable in the process
• Contract employee if incident involved their work
• People with knowledge and experience to thoroughly investigate and analyze the incident

The investigation of the incident should not place blame. It should find the facts! Employees could remain tight lipped about the facts if they know management is on a mission to terminate someone. But that does not mean termination could happen if the incident was intentional.

The incident investigation should be documented on a report and should include:

• Date of incident
• Date investigation began
• Description of the incident
• Factors that contributed to the incident
• Recommendations from the investigation
• Establish a system to promptly address and resolve incident findings and recommendations
• Document the resolutions and corrective actions

All investigation reports must be retained on file for five years

After the investigation report is completed, it shall be reviewed with all affected employees whose job tasks are relevant to the incident findings including contract if applicable. This provides these employees the opportunity for a lessons learned.

Can this incident occur in other areas of the plant or other plants owned by the company? If so, then inform those areas and other companies. It is important for sister companies to share incident report findings so these incidents will not be repeated at other facilities and plants.