5.6 Accident and Injury Report

Question 1

What is the definition of hazard?

Answer 1

A work place condition that might result in injury, health impairment, illness, disease, or death to any worker who is exposed to the condition,

Or which might result in damage to or loss of property or equipment.

Question 2

What is the definition of hazard severity?

Answer 2

An assessment of the worst potential consequence is likely to occur as a result of deficiencies.

Question 3

What is the definition of injury?

Answer 3

A traumatic wound or other condition of the body caused by external force including stress or strain.

Question 4

What is the definition of mishap?

Answer 4

Any unplanned or unexpected event causing death, injury, occupational illness, including days away from work, job transfer or restriction, and material loss or damage.

Question 5

What is the definition of mishap probability?

Answer 5

The likelihood that a hazard will result in a mishap or loss.

Question 6

What is the definition of near mishap?

Answer 6

Is an act or event which injury or damage was avoided merely by chance.

Question 7

What does WESS stand for?

Answer 7

Web Enabled Safety System.

Question 8

What is the definition of WESS?

Answer 8

A web-based safety mishap data collection and reporting system developed for the Navy and Marine Corps by Commander, Naval Safety Center (COMNAVSAFECEN)

Question 9

Mishap Investigation and Reporting Instructions:

What is DODI 6055.07?

Answer 9

Mishap Notification, Investigation, Reporting and Record Keeping.

Question 10

Mishap Investigation and Reporting Instructions:

What is OPNAVINST 5102.1E/MCO 5100.29C?

Answer 10

Navy & Marine Corps Mishap and Safety Investigation, Reporting and Record Keeping Manual.

Question 11

Mishap Investigation and Reporting Instructions:

What is OPNAVINST 3750.6S?

Answer 11

Naval Aviation Safety Management System.

Question 12

Mishap Investigation and Reporting Purposes:

To identify hazards with potential to cause?

Answer 12

Frequent and severe mishaps.

Question 13

Mishap Investigation and Reporting Purposes:

To identify hazards that could cause?

Answer 13

Future mishaps.

Question 14

Mishap Investigation and Reporting Purposes:

To identify unsafe?

Answer 14

Acts and conditions and apply corrective measures.

Question 15

Mishap Investigation and Reporting Purposes:

To identify mishap causal factors and develop appropriate?

Answer 15

Corrective actions which, when implemented, will help prevent similar mishaps.

Question 16

Investigation and Reporting Required Conditions:

Class A, B and C?

Answer 16

Government property damage mishaps.

Question 17

Investigation and Reporting Required Conditions:

Class A, B, and C on-duty?

Answer 17

DoD civilian mishaps and military on/off-duty mishaps.

Question 18

Investigation and Reporting Required Conditions:

Any other work-related illness or injury that involves medical treatment beyond first aid such as?

Answer 18

Loss of consciousness,

Lost work day,

Light duty or limited duty for on/off-duty military personnel.

Question 19

Investigation and Reporting Required Conditions:

Other incidents of interest to who?

Answer 19

The Navy and Marine Corps for mishap prevention purposes.

Question 20

Investigation and Reporting Required Conditions:

All on-duty military fatalities or permanent total disabilities that are the result of a medical event that commenced within one hour of what?

Answer 20

A command-sponsored Physical Training (PT).

Question 21

Investigation and Reporting Required Conditions:

Mishaps occurring as the result of a DoD activity, operation, or evolution that results in what?

Answer 21

The injury or death of a guest or military dependent.

Question 22

Investigation and Reporting Required Conditions:

All on-duty military training-related fatalities, and any high or moderate risk training mishaps that result in the following?

Answer 22

Loss of one training day,

Rolling back or disenrollment of the student from a course.

Question 23

Investigation and Reporting Required Conditions:

All explosive mishaps, including what?

Answer 23

All ordnance impacting off range and all live fire mishaps.

Question 24

Investigation and Reporting Required Conditions:

All on-duty?

Answer 24

Diving cases.

Question 25

Investigation and Reporting Required Conditions:

All afloat cases of what?

Answer 25

Grounding, collision, and flooding.

Question 26

Investigation and Reporting Required Conditions:

All fires occurring where?

Answer 26

Afloat,

All cases except small trash fires in which no personnel were injured and the material property damage was limited to trash.

Question 27

Investigation and Reporting Required Conditions:

All Government Motor Vehicle (GMV) or Government Vehicle Other (GVO) mishaps resulting in what?

Answer 27

$5000 or more government vehicle, government property damage, private vehicle, or private property damage,

Injury/fatality of DoD-personnel, or non-DoD personnel.

Question 28

Investigation and Reporting Required Conditions:

Any medically diagnosed what?

Answer 28

Work-related illness and injury, such as cumulative trauma disorder or musculoskeletal disease.

Question 29

Investigation and Reporting Required Conditions:

Work-related Significant Threshold Shift (STS) in hearing resulting in the following?

Answer 29

Averaging 10 dB or more at 2000, 3000, and 4000 Hz in one or both ears,

The person’s total hearing level is 25 decibels or more above audiometric zero in the same ears(averaged at 2000, 3000, 4000 Hz),

The shift is toward deteriorated hearing, is permanent, and is considered to be of occupational origin.

Question 30

Investigation and Reporting Required Conditions:

Any work-related needle stick injury or cut from a sharp object that is contaminated with what?

Answer 30

Another person’s blood or other potentially infectious material.

Question 31

Investigation and Reporting Required Conditions:

Work-related tuberculosis infection, as evidenced by what?

Answer 31

A positive skin test or diagnosis by a physician, after exposure to a known case of active tuberculosis.

Question 32

Mishap Classifications:

Class A mishap?

Answer 32

The resulting total cost of damages to Government and other property is $2 million or more,

DoD aircraft is destroyed,

An injury or occupational illness results in a fatality or permanent total disability.

Question 33

Mishap Classifications:

Class B mishap?

Answer 33

The resulting total cost of damages to Government and other property is $500,000 or more, but less than $2 million,

An injury or occupational illness results in permanent partial disability,

When three or more personnel are hospitalized for inpatient care as a result of a single mishap.

Question 34

Mishap Classifications:

Class C mishap?

Answer 34

The resulting total cost of property damages to Government and other property is $50,000 or more, but less than $500,000,

Nonfatal injury or illness that results in 1 or more days away from work, not including the day of the injury.

Question 35

Mishap Classifications:

Class D mishap?

Answer 35

The resulting total cost of property damages is $20,000 or more, but less than $50,000,

Recordable injury or illness not otherwise classified as a Class A, B, or C mishap.

Question 36

Mishap Report Types:

Accident and Injury Report?

Answer 36

Medical Department will submit an Accident/Injury Report as directed by the Commanding Officer, on all injuries treated in sickbay in accordance with ship’s policy.

Question 37

Mishap Report Types:

Accident and Injury Report, a copy is sent to who?

Answer 37

Safety Officer.

Question 38

Mishap Report Types:

Safety Investigation Report (SIREP)?

Answer 38

Submitted to Commander, Naval Safety Center (COMNAVSAFECEN).

Using Web-Enabled Safety System (WESS).

Using WESS-DS via e-mail (if internet connectivity is a problem).

Question 39

Mishap Report Types:

Hazard Report (HAZREP)?

Answer 39

Submitted for near-mishaps and situations where lessons learned should be shared.

Question 40

Mishap Report Types:

What are the three types of reports?

Answer 40

Accident and Injury Report,

Safety Investigation Report (SIREP),

Hazard Report (HAZREP).

Question 41

Dissemination Of Mishap Information:

When a Mishap occurs, the Safety Officer is generally notified through what?

Answer 41

Injury report, deck log entry, or by the Department Head.

Question 42

Dissemination Of Mishap Information:

Who is responsible for ensuring an investigation is conducted?

Answer 42

The Safety Officer.

Question 43

Dissemination Of Mishap Information:

Who appoints a mishap investigation board?

Answer 43

The ISIC or higher authority.

Question 44

Dissemination Of Mishap Information:

How many members of a mishap investigation board?

Answer 44

Minimum of 3 Member Team.

Question 45

Dissemination Of Mishap Information:

If a fatality was involved, who may be appointed to the mishap investigation board?

Answer 45

A medical member.

Question 46

Dissemination Of Mishap Information:

The mishap investigation board may be assisted by who?

Answer 46

Technical representatives or NAVSAFECEN personnel,

They are not official members of the board.

Question 47

Dissemination Of Mishap Information:

Encourage free and open disclosure during what?

Answer 47

An investigation.

Question 48

Dissemination Of Mishap Information:

Mishap Investigation Report (MIR) must be submitted within how many days to the Naval Safety Center via chain the command?

Answer 48

30 days.

Question 49

Occupational Injury Recording Forms:

All occupational injuries and illnesses are recorded in the following forms?

Answer 49

SF 600 (Chronological Record of Medical Care)

ETR SF 558 (Emergency Treatment Record),

SF 513 (Consultation),

Accident Injury Report (SAMS Program or Local Form).