Unit 5.6 Accident and Injury reporting

Question 1

Who is required to submit an accident and injury report?

Answer 1

Independent Duty Corpsman

Question 2

Define Hazard

Answer 2

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 3

Define Hazard Severity

Answer 3

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

Question 4

Define Injury

Answer 4

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

Question 5

Define Mishap

Answer 5

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 6

Define Mishap Probability

Answer 6

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

Question 7

Define Near Mishap

Answer 7

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

Question 8

Define Web-Enabled Safety System (WESS)

Answer 8

A web-based safety mishap data collection and reporting system developed for the Navy and Marine Corps by COMNAVSAFECEN

Question 9

Mishap Notification, Investigation, Reporting, and Record Keeping

Answer 9

DODI 6055.07

Question 10

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

Answer 10

OPNAVINST 5102.1D / MCO P5102.1B

Question 11

Naval Aviation Safety Management System (May 14)

Answer 11

OPNAVINST 3750.6S

Question 12

What is the purpose of mishap investigation and reporting?

Answer 12

• Identify hazards with potential to cause frequent and severe mishaps
• Identify hazards that could cause future mishaps
• Identify unsafe acts and conditions and apply corrective measures
• To identify mishap causal factors and develop appropriate corrective actions which, when implemented, will help prevent similar mishaps

Question 13

What condition class’ require a mishap investigation and report?

Answer 13

• Class A, B and C government property damage mishaps

- Class A, B, and C on-duty DoD civilian mishaps and military on/off-duty mishaps

Question 14

What types of illness’ or injuries require investigation and reporting?

Answer 14

Medical treatment beyond first aid

• Loss of consciousness
• Lost work day
• Light duty/LIMDU for on/off duty military personnel

Question 15

How long after a command sponsored PT session, that results in on duty fatalities or permanent disability, require investigation and reporting?

Answer 15

1 hour

Question 16

Mishaps resulting in injury or death of guest or military dependents at what events require investigation and reporting?

Answer 16

DoD activity, operation, or evolution

Question 17

Investigation and reporting required for all on-duty military training-related fatalities, and any high or moderate risk training mishaps that resulting in what?

Answer 17

• Loss of one training day

- Rolling back or disenrollment of the student from a course

Question 18

List other events requiring an investigation and report.

Answer 18

• All explosive mishaps, including all ordnance impacting off range and all live fire mishaps.
• All on-duty diving cases
• All afloat cases of grounding, collision, and flooding
• All fires occurring afloat (all cases except small trash fires in which no personnel were injured and the material property damage was limited to trash)
• All Government Motor Vehicle (GMV) or Government Vehicle Other (GVO) mishaps resulting in:
• $5000 or more government vehicle, government property damage, private vehicle, or private property damage
• Injury/fatality of DoD personnel, or non-DoD personnel
• Any medically diagnosed work-related illness and injury, such as cumulative trauma disorder or musculoskeletal disease.

Question 19

What work-related Significant Threshold Shift (STS) in hearing require investigation and reporting.

Answer 19

• Averaging 10 dB or more at 2000, 3000, and 4000 Hz in one or both ears
• The person’s total hearing level is 25 dB 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 20

Criteria for work-related needle-stick injury or cut from a sharp object that is ?

Answer 20

contaminated with another person’s blood or other potentially infectious material

Question 21

Criteria for work-related tuberculosis infection reporting.

Answer 21

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

Question 22

Describe a class A mishap.

Answer 22

• 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 23

Describe a class B mishap.

Answer 23

• 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 24

Describe a class C mishap.

Answer 24

• 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 25

Describe a class D mishap.

Answer 25

- total cost of property damage 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 26

Describe an accident and injury report.

Answer 26

- Medical Department will submit an Accident/Injury Report as directed by the Commanding Officer, on all injuries treated in sickbay - -- Copy to the Safety Officer

Question 27

Describe a safety investigation report (SIREP)

Answer 27

- 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 28

Describe a hazard report (HAZREP)

Answer 28

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

Question 29

When a Mishap occurs who is notified and what is used to notify?

Answer 29

- Safety Officer | - -- injury report, deck log entry, or by Dept. Head

Question 30

What is the Safety Officer responsible for if notified of a mishap?

Answer 30

- Ensure an investigation is conducted.

Question 31

Who appoints a mishap investigation board and describe the board.

Answer 31

- ISIC or Higher Authority - -- Minimum of 3 member team - -- If fatality was involved, a medical member may be appointed to the board - -- May be assisted by technical representatives or NAVSAFECEN personnel; they are not official members of the board - -- Encourage free and open disclosure during an investigation - -- Mishap Investigation Report (MIR) must be submitted within 30 days to the Naval Safety Center via chain the command

Question 32

LIST the forms used in recording of occupational injuries and illnesses.

Answer 32

- SF 600 (Chronological Record of Medical Care) - ETF SF 558 (Emergency Treatment Record) - SF 513 (Consultation) - Accident Injury Report (SAMS Program or Local Form)