Accident and Injury Report

Question 1

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

hazard severity

Answer 2

an assessment of the worst potential consequences is likely to occur as a result of deficiencies

Question 3

injury

Answer 3

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

Question 4

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

mishap probability

Answer 5

the likelihood that a hazard will result in a mishap or loss

Question 6

near mishap

Answer 6

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

Question 7

Web Enabled Safety System (WESS)

Answer 7

a web based safety mishap data collection and reporting system developed for the Navy and Marine Corps by COMNAVSACECEN.

Question 8

what are the mishap investigation and reporting instructions:

Answer 8

DODI 6055.07
OPNAVINST 5102.1D/MCO P5102.1B
OPNAVINST 3750.6S

Question 9

What is “Mishap Notification, Investigation, Reporting and Record Keeping” Instruction number?***

Answer 9

DODI 6055.07 (06 Jun 2011)

Question 10

What is “Navy and Marine Corps Mishap and Safety Investigation, Reporting and Record Keeping Manual” Instruction?

Answer 10

OPNAVINST 5102.1D/MCO P5102.1B (07 Jan 2005)

Question 11

What is “Naval Aviation Safety Management System” Instruction?

Answer 11

OPNAVINST 3750.6S (May 14)

Question 12

Mishap Investigation and Reporting Purposes:

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 which, when implemented, will help prevent similar mishaps.

Question 13

Class A mishap?

Answer 13

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 14

Class B mishap?

Answer 14

The resulting total cost of damages to Government and other property is 500,000 or more, but less than 2 million/ and 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 15

Class C mishap?

Answer 15

the resulting total cost of property damages to Government property is 50,000 but less than 500,000/ not fatal injury or illness that results in 1 or more days away from work not including the day of the injury.

Question 16

class D mishap?

Answer 16

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,B, or C mishap.

Question 17

3 types of mishap reports:

Answer 17

accident and injury report

Safety Investigation Report (SIREP)

Hazard Report (HAZREP)

Question 18

Accident and injury Report

Answer 18

Medical Dept will submit an accident/injury report as directed by the Commanding Officer, on all injuries treated in sickbay in accordance with the ships policy.

(Copy to Safety Officer)

Question 19

Safety Investigation Report (SIREP)

Answer 19

submitted to Commander, Naval Safety Center (COMNAVSAFECEN)

Using web enabled Safety System (WESS)

Question 20

Hazard Report (HAZREP)

Answer 20

submitted for near mishaps and situation where lessons learned should be shared.

Question 21

Dissemination of Mishap Information: Safety Officer

Answer 21

generally notified through injury report, deck log entry, or by DH.

responsible for ensuring an investigation is conducted.

Question 22

Who appoints a mishap investigation board?

Answer 22

ISIC or higher authority.

Question 23

minimum number on a mishap investigation board?

Answer 23

three

Question 24

Who may be appointed to the Mishap Investigation Board if there was a fatality on board?

Answer 24

Medical

Question 25

Who may assist the mishap investigation board but is not an official member of the board?

Answer 25

a technical representative or NAVSAFECEN personnel.

Question 26

mishap investigation report must be submitted within how many day to the Naval Safety Center via Chain of Command?

Answer 26

30 days

Question 27

Occupational injury recording forms

Answer 27

SF 600
SF 513 (consults)
Accident injury report (SAMS program or local forms)