5.6 ACCIDENT AND INJURY REPORT

Question 1

Who submits accident and injury reports?

Answer 1

IDC

Question 2

Hazard

Answer 2

work place condition that might result in injury, health impairment,
illness, disease, or death

Question 3

hazard severity

Answer 3

assessment of the worst potential consequence is likely to occur

Question 4

injury

Answer 4

condition of the body caused by external force
including stress or strain.

Question 5

mishap

Answer 5

unplanned or unexpected event causing death, injury, occupational
illness, including days away from work, job

Question 6

mishap probability

Answer 6

likelihood that a hazard will result in a mishap or loss

Question 7

near mishap

Answer 7

event which injury or damage was avoided merely by chance

Question 8

Web Enabled Safety System (WESS)

Answer 8

web-based safety mishap data collection and reporting system to Safety Center

Question 9

DODI 6055.07

Answer 9

Mishap Notification, Investigation, Reporting and Record
Keeping.

Question 10

OPNAVINST 5102.1E/MCO 5100.29C

Answer 10

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

Question 11

OPNAVINST 3750.6S

Answer 11

Naval Aviation Safety Management System

Question 12

purpose of Mishap Investigation and Reporting

Answer 12

(1) To identify hazards with potential to cause frequent and severe mishaps.
(2) To identify hazards that could cause future mishaps.
(3) To identify unsafe acts and conditions and apply corrective measures.
(4) To identify mishap causal factors and develop appropriate corrective actions

Question 13

Investigation and Reporting Required Conditions

Answer 13

(1) Class A, B and C government property damage mishaps.
(2) Class A, B, and C on-duty DoD civilian mishaps and military on/off-duty mishaps.
(3) Any other work-related illness or injury that involves medical treatment beyond first
aid.

Question 14

Additional Investigation and Reporting Required Conditions pt 2

Answer 14

incidents of interest to the Navy and Marine Corps for mishap prevention
purposes.
-military fatalities within one hour of a command-sponsored Physical training (PT)
-result of a DoD activity, operation, or evolution that results in
the injury or death of a guest or military dependent.

Question 15

Additional Investigation and Reporting Required Conditions pt 3

Answer 15

-on-duty military training-related fatalities, and any high or moderate risk training
mishaps that result in the: loss of 1 training day or roll back/disenrollment
-All explosive mishaps
-All on-duty diving cases
All afloat cases of grounding, collision, and flooding.

Question 16

Additional Investigation and Reporting Required Conditions pt 4

Answer 16

-All fires occurring afloat
-All Government Motor Vehicle (GMV) or Government Vehicle Other (GVO) greater than $5K in damage or fatality
-medically diagnosed work-related illness and injury
-Significant Threshold Shift (STS) in hearing (10 db @ 2k,3k,4k hz)

Question 17

Additional Investigation and Reporting Required Conditions pt 5

Answer 17

-work-related needle stick injury or cut from a sharp object
-Work-related tuberculosis infection

Question 18

Class A mishap

Answer 18

-resulting total cost of damages 2 million or more
-aircraft is destroyed
-illness results in fatality

Question 19

class b mishap

Answer 19

-total cost of damages is
$500,000 or more, but less than $2 million
-permanent partial disability
-three or more personnel are hospitalized single mishap

Question 20

class c mishap

Answer 20

-property damages are $50,000 or more, but less than $500,000
-Nonfatal injury or illness results in 1 or more days away from work

Question 21

class d mishap

Answer 21

-cost of property damages is $20,000 or more, but less than $50,000.
-injury or illness not otherwise classified as A B C

Question 22

Accident and Injury Rep

Answer 22

Medical Department will submit an Accident/Injury Report as directed by
the Commanding Officer, on all injuries treated in sickbay. copy to safety officer

Question 23

Safety Investigation Report (SIREP)

Answer 23

(a) Submitted to Commander, Naval Safety Center (COMNAVSAFECEN).
(b) Using Web-Enabled Safety System (WESS).
(c) Using WESS-DS via e-mail (if internet connectivity is a problem).

Question 24

Hazard Report (HAZREP

Answer 24

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

Question 25

How is Safety Officer informed of mishap?

Answer 25

Through injury report, deck log entry or Department Head

Question 26

Who is responsible for ensuring mishap investigation is conducted?

Answer 26

Safety Officer

Question 27

Who appoints Mishap investigation board?

Answer 27

ISIC

Question 28

Requirements for mishap investigation board?

Answer 28

(1) Minimum of 3 Member Team
(2) If fatality, a medical member may be appointed to the board.
(3) May be assisted by technical representatives or NAVSAFECEN.
(4) Encourage free and open disclosure during an investigation.
(5) Mishap Investigation Report (MIR) must be submitted within 30 days to the Safety Center.

Question 29

Required Occupational Injury Recording Forms

Answer 29

(a) SF 600 (Chronological Record of Medical Care)
(b) ETR SF 558 (Emergency Treatment Record)
(c) SF 513 (Consultation)
(d) Accident Injury Report (SAMS Program or Local Form)