Module 1

 Were hazardous products involved?
 Were they clearly identified?
 Was a less hazardous alternative product possible and available?
 Was the raw material substandard in some way?
 Should personal protective equipment (PPE) have been used?
 Was the PPE used?
 Were users of PPE properly educated and trained?
Again, each time the answer reveals an unsafe condition, the investigator must ask why this
situation was allowed to exist.

Work Environment

The physical work environment, and especially sudden changes to that environment, are
factors that need to be identified. The situation at the time of the incident is what is
important, not what the "usual" conditions were. For example, investigators may want to
know:

 What were the weather conditions?
 Was poor housekeeping a problem?
 Was it too hot or too cold?
 Was noise a problem?
 Was there adequate light?
 Were toxic or hazardous gases, dusts, or fumes present?

Personnel

The physical and mental condition of those individuals directly involved in the event must be
explored, as well as the psychosocial environment they were working within. The purpose for
investigating the incident is not to establish blame against someone but the inquiry will not
be complete unless personal characteristics or psychosocial factors are considered. Some
factors will remain essentially constant while others may vary from day to day:

 Did the worker follow the safe operating procedures?
 Were workers experienced in the work being done?

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 Had they been adequately educated and trained?
 Can they physically do the work?
 What was the status of their health?
 Were they tired?
 Was fatigue or shift work an issue?
 Were they under stress (work or personal)?
 Was there pressure to complete tasks under a deadline, or to by-pass safety

procedures?

Management

Management holds the legal responsibility for the safety of the workplace and therefore the
role of supervisors and higher management and the role or presence of management
systems must always be considered in an incident investigation. These factors may also be
called organizational factors. Failures of management systems are often found to be direct or
indirect causes. Ask questions such as:

 Were safety rules or safe work procedures communicated to and understood by all
employees?

 Were written procedures and orientation available?
 Were the safe work procedures being enforced?
 Was there adequate supervision?
 Were workers educated and trained to do the work?
 Had hazards and risks been previously identified and assessed?
 Had procedures been developed to eliminate the hazards or control the risks?
 Were unsafe conditions corrected?
 Was regular maintenance of equipment carried out?
 Were regular safety inspections carried out?
 Had the condition or concern been reported beforehand?
 Was action taken?
This model of incident investigation provides a guide for uncovering all possible causes and
reduces the likelihood of looking at facts in isolation. Some investigators may prefer to place
some of the sample questions in different categories; however, the categories are not

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important, as long as each question is asked. Obviously, there is considerable overlap
between categories; this overlap reflects the situation in real life. Again, it should be
emphasized that the above sample questions do not make up a complete checklist, but are
examples only.
How are the facts collected?
The steps in the investigation are simple: the investigators gather data, analyse it, determine
their findings, and make recommendations. Although the procedures are seemingly
straightforward, each step can have its pitfalls. As mentioned above, an open mind is
necessary in an investigation: preconceived notions may result in some wrong paths being
followed while leaving some significant facts uncovered. All possible causes should be
considered. Making notes of ideas as they occur is a good practice but conclusions should not
be made until all the data is gathered.

Physical Evidence

Before attempting to gather information, examine the site for a quick overview, take steps to
preserve evidence, and identify all witnesses. In some jurisdictions, an incident site must not
be disturbed without approval from appropriate government officials such as the coroner,
inspector, or police. Physical evidence is probably the most non-controversial information
available. It is also subject to rapid change or obliteration; therefore, it should be the first to
be recorded. Based on your knowledge of the work process, you may want to check items
such as:

 positions of injured workers
 equipment being used
 products being used
 safety devices in use
 position of appropriate guards
 position of controls of machinery
 damage to equipment
 housekeeping of area
 weather conditions
 lighting levels

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 noise levels
 time of day
You may want to take photographs before anything is moved, both of the general area and
specific items. A later study of the pictures may reveal conditions or observations that were
missed initially. Sketches of the scene based on measurements taken may also help in later
analysis and will clarify any written reports. Broken equipment, debris, and samples of
materials involved may be removed for further analysis by appropriate experts. Even if
photographs are taken, written notes about the location of these items at the scene should
be prepared.

Witness Accounts

Although there may be occasions when you are unable to do so, every effort should be made
to interview witnesses. In some situations, witnesses may be your primary source of
information because you may be called upon to investigate an incident without being able to
examine the scene immediately after the event. Because witnesses may be under severe
emotional stress or afraid to be completely open for fear of recrimination, interviewing
witnesses is probably the hardest task facing an investigator.
Witnesses should be kept apart and interviewed as soon as possible after the incident. If
witnesses have an opportunity to discuss the event among themselves, individual
perceptions may be lost in the normal process of accepting a consensus view where doubt
exists about the facts.
Witnesses should be interviewed alone, rather than in a group. You may decide to interview a
witness at the scene where it is easier to establish the positions of each person involved and
to obtain a description of the events. On the other hand, it may be preferable to carry out
interviews in a quiet office where there will be fewer distractions. The decision may depend
in part on the nature of the incident and the mental state of the witnesses.

Interviewing

The purpose of the interview is to establish an understanding with the witness and to obtain
his or her own words describing the event:

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DO...
 put the witness, who is probably upset, at ease
 emphasize the real reason for the investigation, to determine what happened and
why
 let the witness talk, listen
 confirm that you have the statement correct
 try to sense any underlying feelings of the witness
 make short notes or ask someone else on the team to take them during the interview
 ask if it is okay to record the interview, if you are doing so
 close on a positive note

DO NOT...
 intimidate the witness
 interrupt
 prompt
 ask leading questions
 show your own emotions
 jump to conclusions

Ask open-ended questions that cannot be answered by simply "yes" or "no". The actual
questions you ask the witness will naturally vary with each incident, but there are some
general questions that should be asked each time:

 Where were you at the time of the incident?
 What were you doing at the time?
 What did you see, hear?
 What were the work environment conditions (weather, light, noise, etc.) at the time?
 What was (were) the injured worker(s) doing at the time?
 In your opinion, what caused the incident?
 How might similar incidents be prevented in the future?
Asking questions is a straightforward approach to establishing what happened. But, care
must be taken to assess the accuracy of any statements made in the interviews.
Another technique sometimes used to determine the sequence of events is to re-enact or
replay them as they happened. Care must be taken so that further injury or damage does not

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occur. A witness (usually the injured worker) is asked to re-enact in slow motion the actions
that happened before the incident.

Other Information

Data can be found in documents such as technical data sheets, health and safety committee
minutes, inspection reports, company policies, maintenance reports, past incident reports,
safe-work procedures, and training reports. Any relevant information should be studied to
see what might have happened, and what changes might be recommended to prevent
recurrence of similar incidents.

What should I know when making the analysis and recommendations?

At this stage of the investigation most of the facts about what happened and how it
happened should be known. This data gathering has taken considerable effort to accomplish
but it represents only the first half of the objective. Now comes the key question - why did it
happen?
Keep an open mind to all possibilities and look for all pertinent facts. There may still be gaps
in your understanding of the sequence of events that resulted in the incident. You may need
to re-interview some witnesses or look for other data to fill these gaps in your knowledge.
When your analysis is complete, write down a step-by-step account of what happened (the
team’s conclusions) working back from the moment of the incident, listing all possible causes
at each step. This is not extra work: it is a draft for part of the final report. Each conclusion
should be checked to see if:

 it is supported by evidence
 the evidence is direct (physical or documentary) or based on eyewitness accounts, or
 the evidence is based on assumption.
This list serves as a final check on discrepancies that should be explained.

Why should recommendations be made?

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The most important final step is to come up with a set of well-considered recommendations
designed to prevent recurrences of similar incidents. Recommendations should:

 be specific
 be constructive
 identify root causes
 identify contributing factors
Resist the temptation to make only general recommendations to save time and effort.
For example, you have determined that a blind corner contributed to an incident. Rather
than just recommending "eliminate blind corners" it would be better to suggest:
 install mirrors at the northwest corner of building X (specific to this incident)
 install mirrors at blind corners where required throughout the worksite (general)
Never make recommendations about disciplining a person or persons who may have been at
fault. This action would not only be counter to the real purpose of the investigation, but it
would jeopardize the chances for a free flow of information in future investigations.
In the unlikely event that you have not been able to determine the causes of an incident with
complete certainty, you probably still have uncovered weaknesses within the process, or
management system. It is appropriate that recommendations be made to correct these
deficiencies.

The Written Report
The prepared draft of the sequence of events can now be used to describe what happened.
Remember that readers of your report do not have the intimate knowledge of the incident
that you have so include all relevant details, including photographs and diagrams. Identify
clearly where evidence is based on certain facts, witness accounts, or on the team’s
assumptions.
If doubt exists about any particular part of the event, say so. The reasons for your conclusions
should be stated and followed by your recommendations. Do not include extra material that
is not required for a full understanding of the incident and its causes such as photographs
that are not relevant and parts of the investigation that led you nowhere. The measure of a
good report is quality, not quantity.

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Always communicate your findings and recommendations with workers, supervisors and
management. Present your information 'in context' so everyone understands how the
incident occurred and the actions needed to put in place to prevent it from happening again.
Some organizations may use pre-determined forms or checklists. However, use these
documents with caution as they may be limiting in some cases. Always provide all of the
information needed to help others understand the causes of the event, and why the
recommendations are important.

What should be done if the investigation reveals human error?
A difficulty that has bothered many investigators is the idea that one does not want to lay
blame. However, when a thorough worksite investigation reveals that some person or
persons among management, supervisor, and the workers were apparently at fault, then this
fact should be pointed out. The intention here is to remedy the situation, not to discipline an
individual.
Failing to point out human failings that contributed to an incident will not only downgrade
the quality of the investigation, it will also allow future incidents to happen from similar
causes because they have not been addressed.
However never make recommendations about disciplining anyone who may be at fault. Any
disciplinary steps should be done within the normal personnel procedures.

How should follow-up be done?
Management is responsible for acting on the recommendations in the investigation report.
The health and safety committee or representative, if present, can monitor the progress of
these actions.
Follow-up actions include:

 Respond to the recommendations in the report by explaining what can and cannot be
done (and why or why not).

 Develop a timetable for corrective actions.
 Monitor that the scheduled actions have been completed.
 Check the condition of injured worker(s).
 Educate and train other workers at risk.
 Re-orient worker(s) on their return to work.

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Explain the difference between an accident and incident (NQF
Level: 2)

Accident & Incident Investigation
How many accidents has your company recorded in the past year? Does that number include
the number of incidents? Or aren't they reported? A company can't afford to shrug such
questions off. It is imperative to conduct workplace accident investigations and workplace
incident investigations in every instance, in order to prevent recurrence.

Accident versus Incident
An accident investigation is an investigation into an undesired event that happens
unexpectedly and unintentionally and results in personal injury or in property damage.

An incident investigation is an investigation into an unplanned, undesired event
that may not cause injury or damage, but hinders the completion of a task.

An incident may not cause injury or damage the first time it happens but it has the potential
in the future to do so, hence the expression "near miss". In many cases, people refer to
accident and incident as one and the same.

Why conduct an investigation?
One of the best ways to avoid accidents and incidents from reoccurring is to understand how
they occurred in the first place. A thorough investigation will identify the root causes of the
accident or incident and answer the questions "What happened?", "Why did that happen?"
and "How can we guard against future recurrences?"

How can ARMS Reliability help you with a workplace accident & incident investigation?

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ARMS Reliability can either supply the impartiality with its comprehensive investigation
services, utilizing the Apollo Root Cause Analysis methodology, or train your own people to
lead these investigations and facilitate the analyses.

Apollo Root Cause Analysis methodology for incident investigations and accident
investigations

The Apollo Root Cause Analysis methodology is the perfect tool for accident investigations
and incident investigations. It facilitates the creation of a common reality using input from all
stakeholders to produce an evidence-based understanding of the problem - ensuring your
solutions address proven causes and prevent recurrence.

An effective and embedded RCA program in your organization can help to address and
improve:

Lost time due to accidents Non-conformance with legal or internal
standards
Reportable accidents Safety breaches
Defect elimination Environmental impacts
Risk management Customer complaints

When should you conduct an investigation?
It is imperative that both major and minor accidents and incidents are investigated. The need
for a thorough investigation into something that is considered as minor could prove very
fruitful.

The investigation will identify the hazards (causes) that could lead to a more serious accident
or incident if the conditions are left uncorrected.

Who should be involved in the RCA investigation?

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All employees, at any level of an organization can be trained in RCA and participate
constructively in the investigation. However, those who may find it most valuable include:

Engineers Managers
Reliability Practitioners Operators
Safety Officers Human Resources Personnel
Team Leaders Customer Service Personnel
Logistics Team Healthcare Managers

OH&S and RCA

Organizations have a duty of care to ensure as far as reasonably practicable the health and
safety of their employees and others by identifying hazards, quantifying the associated risks
and implementing control measures to prevent their actuation of the hazards. To fulfil this
duty, it is important for organizations to conduct investigations when workplace accidents or
incidents occur.

RCA enables your organization to satisfy OH&S regulatory standards. Some of the various
ways RCA enables an organization to meet these standards include:
Documentation of a thorough and formal investigation report (i.e. the output from training is
that your team will learn how to generate a standard accident and incident investigation
report)
Analysis of near-misses
Achieve and maintain quality control standards
Waste management
Supply control

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Topic Quiz
1. When should you conduct an investigation?

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Describe the generally accepted hierarchy of how incidents lead to
accidents (NQF Level: 2)

An incident is an event that could lead to loss of, or disruption to, an organization's
operations, services or functions. Incident management (ICM) is a term describing the
activities of an organization to identify, analyze, and correct hazards to prevent a future re-
occurrence.

Explain the basic process of accident and incident investigation
(NQF Level: 2)

The Incident Investigation
Six steps for successful incident investigation
Organizations investigate business upsets because they are required to by law or their own
company standards, or the public or shareholders expect it. Investigations often find that
similar scenarios have occurred previously but, for a variety of reasons, did not result in
serious consequences. This is increasingly recognized in high-risk industries where "near
misses" are also investigated as well as incidents which actually resulted in loss.
A six-step, structured approach to incident investigation (Fig 1) helps to ensure that all the
causes are uncovered and addressed by appropriate actions.

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Step 1 - Immediate action
In the event of an incident, immediate action to be taken may include making the area safe,
preserving the scene and notifying relevant parties. The investigation begins even at this
early stage, by collecting perishable evidence, e.g. CCTV tapes, samples.

Step 2 - Plan the investigation
Planning ensures that the investigation is systematic and complete. What resources will be
required? Who will be involved? How long will the investigation take? For severe or complex
incidents, an investigation team will be more effective than a single investigator.

Step 3 - Data collection
Information about the incident is available from numerous sources, not only people involved
or witnesses to the event, but also from equipment, documents and the scene of the
incident.

Step 4 - Data analysis
Typically, an incident is not just a single event, but a chain of events. The sequence of events
needs to be understood before identifying why the incident happened.

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When asking why, we need to identify the root and underlying causes, as well as the direct
causes. Failures and mistakes don't just happen by themselves; organizations allow error-
enforcing environments that encourage direct causes to develop and persist. Such
environments, and the basic management failings behind them, are the root causes - the
ultimate source of the incident.
While human error plays a part in the majority of incidents, people are not generally stupid,
lazy, forgetful or wilfully negligent. Human errors occur because of influencing factors
associated with the work, the environment, an individual's mental or physical abilities, the
organization and its management systems. Any investigation which sets out to find someone
to blame is misguided.
Step 5 - Corrective actions
Many investigations make the mistake of raising actions which deal only with the direct
causes - a quick fix, putting last-lines-of- defense back in place. By ignoring the root and
underlying causes, not only do they miss an opportunity to reduce the risk of recurrence of
the incident, but they also leave open the possibility that other, dissimilar incidents may also
occur, arising from the same, common root cause (Fig 2).

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Step 6 - Reporting
The investigation is concluded when all outstanding issues have been closed out and the
findings have been communicated so that lessons can be shared. Communication
mechanisms include formal incident investigation reports, alerts, presentations and meeting
topics.

Topic Quiz
1. What is an accident?

2. List six steps for successful incident investigation

The Seven Steps of a Thorough Accident Investigation
The investigator’s role is to gather and organize information in an effort to uncover the truth
behind the incident.

1. Respond immediately
The most immediate task is to coordinate the company’s emergency response. In addition to
notifying emergency responders and attending to injuries and damage, this also includes
notification of all appropriate personnel (and workers’ family members), and securing the site
to ensure that a proper investigation can take place.

2. Gather information
Once the accident site has been secured, the investigator’s focus shifts to gathering as much
data about the incident as possible. It’s critical that this process begin immediately, before
witnesses begin to forget details and before regular work compromises any evidence.

3. Release the scene
While it would be ideal to keep the site of the incident secure while the investigation
proceeds, in most cases that just isn’t practical. That’s especially true when incidents occur
on construction sites, where unnecessary delays can be costly.

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4. Perform the analysis
At this stage, the investigator has access to all of the available data and is ready to determine
what happened and how. The most effective way to analyze is to organize all of the events in
two formats. First, they should be listed chronological order, providing a step-by-step
recounting of the incident.

5. Develop a report
Documentation is a key part of any safety program, and is particularly important when
investigating accidents. A clear, comprehensive report collects all the facts so that everyone
is working from the same information and can refer back to it (instead of trusting our
imperfect memories). A report will also be helpful if litigation becomes necessary, since that
typically takes place many months or even years after the actual incident.

6. Share the findings
Much of the value of an accident investigation rests in its ability to prevent future incidents.
That’s why it’s so important to share the report’s findings and any recommendations with
everyone from the management team through workers.

7. Make changes
Finally, it’s time to implement the investigator’s recommendations and make any necessary
changes to processes and procedures to ensure that there won’t be a repeat of the incident.
Part of making that change is regular follow-up to ensure that the correct steps are being
taken. That way, the time and energy that have been invested into the accident investigation
will have been worthwhile.

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FORMATIVE ASSESEMENT - EIGHT
 IAC0801 Using a practical workplace example describe the process of investigating accidents and

incidents (Weight: 5%)

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1.2.9. KM-01-KT09: Roles and responsibilities of the
various stakeholders in a workplace regarding
Occupational Health and Safety (Intermediate)

KT0901 List the key stakeholders that are involved in the prevention of accidents and incidents in
the workplace (NQF Level: 2)

KT0902 Describe the role of each of the key stakeholders in preventing accidents and incidents
KT0903 Explain the consequences when a stakeholder does not execute their duty in

accident/incident prevention (NQF Level: 2)
KT0904 Explain the role of the safety representative when one of the other stakeholders do not do

what is expected of them (NQF Level: 2)

 Role of the safety representative
 The role of each of the key stakeholders in preventing accidents and incidents
 The key stakeholders that are involved in the prevention of accidents and incidents in the

workplace

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Roles and responsibilities of the various stakeholders in a
workplace regarding Occupational Health and Safety (Intermediate)

What Are the Stakeholders' Roles in a Company?
The word “stakeholder” means any person with an interest in the business -- someone who
can contribute to the company’s growth and success or who benefits from its success. The
various stakeholders in a business have differing roles and their level of involvement in the
enterprise varies from full-time to barely involve at all.

Employees
Employees are the closest to the action. They interact with customers on a daily basis. In a
manufacturing environment, they work directly on the company’s products. The company’s
success depends in large measure on the skill and dedication of its employees. Without the
employees performing their roles proficiently, the company will not reach its revenue and
profit potential.

Stockholders
Stockholders’ initial role is to provide the capital a company needs to grow and expand, or in
the case of a startup venture, the capital it needs to launch its products or services into the
marketplace. They sometimes provide guidance or advice to the company’s management.

Customers
The reason for a company’s existence is to provide products or services that meet the needs
of its target customers and benefit them in a meaningful way. The role of customers is critical
to the company’s survival and success. Through the purchase decisions they make each day,
they select which companies will prosper and which will fail.
The Community
The community provides the skilled workforce that a company depends upon to maintain its
competitive edge. Members of the community, including the news media, often play a

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watchdog role, ensuring that the company is a good citizen with fair business practices,
concern for the environment, and a willingness to contribute to charitable and social causes.

WSH Act: responsibilities of stakeholders
The Workplace Safety and Health (WSH) Act defines the responsibilities for
each stakeholder group, such as employers, occupiers, employees and self-employed.
Under the WSH Act, the stakeholders and their responsibilities are as follows:

Employer

As an employer, you must protect the safety and health of your employees or workers
working under your direction, as well as persons who may be affected by their work.
You must:
 Conduct risk assessments to identify hazards and implement effective risk control

measures.
 Make sure the work environment is safe.
 Make sure adequate safety measures are taken for any machinery, equipment, plant,

article or process used at the workplace.
 Develop and implement systems for dealing with emergencies.
 Ensure workers are provided with sufficient instruction, training and supervision so

that they can work safely.

Principal
A principal is any person or organization who engages another person or organization to
supply labor or perform work under a contract for service.
As a principal, you must ensure that the contractor you engage:
 Is able to perform the work they are engaged for.
 Has made sure that any machinery, equipment, plant, article or process that is used at

work is safe.

Occupier

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In workplaces registered or notified as a factory, the occupier is the person who holds the
certificate of registration. In all other workplaces, the occupier is the person who has
control of the premises, regardless of whether they are the owner of those premises.

As an occupier, you must ensure that the following are safe:
 The workplace.
 All pathways to and from the place of work.
 Machinery, equipment, plants, articles and substances.
You must ensure that the above does not pose a risk to anyone within your premises,
even if the person is not your employee.
You may also be responsible for the common areas used by your employees and
contractors. Common areas include the following:
 Electric generators and motors.
 Hoists and lifts, lifting gears, lifting appliances and lifting machines.
 Entrances and exits.
 Machinery and plants.

Manufacturer or supplier
As a manufacturer or supplier, you must ensure that any machinery and
equipment or hazardous substances you provide are safe.
You must:
 Provide information on health hazards and how to safely use the machinery,

equipment or hazardous substance.
 Examine and test the machinery, equipment or hazardous substance to ensure that it

is safe for use.
 Provide results of any examinations or tests of the machinery, equipment or

hazardous substances.

Installer or erector of machinery
You must ensure that the machinery and equipment that you have erected, installed or
modified is safe and without safety or health risks when properly used.

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Employee
As an employee, you must:
 Follow the workplace safety and health system, safe work procedures or safety rules

implemented at the workplace.
 Not engage in any unsafe or negligent act that may endanger yourself or others

working around you.
 Use personal protective equipment provided to you to ensure your safety while

working. You must not tamper with or misuse the equipment.

Topic Quiz
1. What Are the Stakeholders' Roles in a Company?

2. List responsibilities of stakeholders

Being in employment is health enhancing, with people in employment enjoying better levels
of health than those who are unemployed
(Waddell, 1). In addition to providing an income, work can also lead to improved self-image, a
sense of purpose to life, social interaction and personal development (Waddell, 1).
The workplace has long been considered a suitable setting in which to promote health and
well-being. There are several reasons for this, not least of which is that the workplace is a
setting in which a large proportion of the adult (working aged) population can be reached
with messages about health and well-being. Associated with this is that many people who
make up the workforce come from groups who are traditionally hard to reach with messages
about health, wellbeing and lifestyle, such as males and lower socio-economic groups.

A second major driver for workplace health promotion (WHP hereafter) is that it has a
positive impact on the economic well-being of an organisation and, in turn, the creation of
wealth in the community as a whole. Key reasons that provide a rationale for WHP activity
include:

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 The aging population in many countries and the need to have older people who can
remain healthy and economically active

 The increasing diversity of the workforce
 The requirement for high levels of workability among employees
 The need to recruit and retain high quality employees

To have a workforce that is fit, flexible and efficient (workability) requires an organisation to
have policies and approaches that:
 Enable and equip people to remain in work later in life
 Reduce the loss of experienced workers from the workforce i.e. improve retention
 Improve the quality of life both inside and outside work for all workers especially older

workers

Concepts in accident prevention

 Primary prevention: removal of circumstances causing injury - e.g., traffic speed
reduction, fitting stair gates for young children, reducing alcohol consumption.

 Secondary prevention: reduces severity of injury should an accident occur - e.g., use child
safety car seats, bicycle helmets, smoke alarms.

 Tertiary prevention: optimal treatment and rehabilitation following injuries - e.g.,
effective first aid, appropriate hospital care.

Role of clinicians in accident prevention

Clinical roles for health professionals in accident prevention

These include:
 Advice to patients: health workers are well placed to identify accident risks or medical

conditions conferring risk and to advise accordingly - for example:
 Child accident prevention:

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 Identify hazards (on home visits or if treatment sought for accidental
injury).

 Advise about prevention - e.g., stair gates, keeping chemicals out of
reach, etc.

 Patients with medical conditions:
 Identify and treat accident-causing conditions - e.g., obstructive sleep
apnoea, visual or balance disorders.
 Give appropriate advice on fitness to drive.
 Advise patients on how to minimise accident risks from their medical
condition.

 Identify unacceptable risks and intervene where appropriate - for example:
 Identify vulnerable children and adults with recurrent injuries or at high risk.
This includes those who are experiencing neglect and may require child protection
procedures.
 Consider reporting to the Driver and Vehicle Licensing Agency (DVLA) patients
who fail to comply with medical driving regulations, if they are a serious risk to the
public.

 Accident surveillance: health professionals and their organisations can monitor injury
rates and report preventable accidents; it has been suggested that A&E departments
could play a key role. NICE recommends establishing local protocols to alert health
visitors, school nurses and GPs when a child or young person repeatedly needs treatment
for unintentional injuries at an emergency department or minor injuries unit. On a
national basis, NICE recommends ensuring that all hospital trusts are made aware of the
data collection requirements for the universal and mandatory A&E (minimum)
commissioning dataset.

Non-clinical interventions
These include:
 Advocacy and policy making.
 Collaboration with other agencies.
 Promoting accident prevention education and training.
 Research.

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How effective are interventions by health professionals?

Research into child safety practices suggests that safety advice for families can be effective.
Cochrane reviews found that:
 Home safety education (usually given in a face-to-face setting), particularly with the

provision of safety equipment, is effective in increasing safety practices.
 Parenting interventions (usually home-based) may be effective in preventing childhood

injury.

How well do health workers perform in the role of accident prevention?

Health professionals could improve their awareness and involvement in accident prevention.
For example:
 A 2003 survey of primary care organisation (PCO) board members, including GPs, found

limited knowledge of and low prioritisation of accident prevention compared with other
health promotion activities.
 Health professionals are generally positive about their involvement in child accident
prevention but legislative and engineering measures may need to be addressed in order
to make their role more effective.
 A study assessing the impact of child injury prevention training of midwives and health
visitors suggested this had a positive effect on parental safety behaviours, the adoption of
safety practices and injury reduction but that large-scale studies were required.

Accident prevention advice

This section is intended to outline the major causes of accidents in the UK and to give health
professionals some knowledge of how these can be prevented. Advice tips can be found
under headings 'Safety advice for carers of young children', 'Home accident prevention' and
'Road accident prevention advice', below.
Specific medical conditions

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Doctors are well placed to advise patients on accident risks relevant to their medical
problems. For example:
 Sleep disorders:

 These may be under-recognised and underdiagnosed.
 Tools such as the Epworth Sleepiness Scale and expertise such as sleep

disorder clinics are valuable.
 Diabetes:

 Hypoglycaemia is an important cause of driving mishaps in those with type I
diabetes. It is a risk where hypoglycaemic agents are used. Drivers should take
precautions such as checking their blood glucose before driving, taking meals and
snacks and not ignoring symptoms of hypoglycaemia.

 Research suggests that people with diabetes at highest risk are those with a
history of mismanagement of hypoglycaemia, lower limb neuropathy or greater
exposure, i.e. high-volume driving.

 Epilepsy:
 People with poorly controlled epilepsy can be advised how to minimise their
risks of injury during a seizure - e.g., take a shower instead of a bath, do not iron
when alone and other tips. Identified risk factors for injuries include the number
of anti-epileptic drugs, history of generalised seizures and seizure frequency.

 Attention deficit hyperactivity disorder:
 ADHD has been shown to be associated with an increased risk of serious
transport accidents. There is evidence that this risk is reduced by medication in
male patients but not in females.

Accidents and children

Accidents are one of the main causes of death among children aged 1-5 years. About 100,000
children are admitted to hospital annually in the UK and 2 million attend emergency
departments. In a typical CCG with a population of 100,000, this equates to approximately
3,300 emergency departments visit and 200 hospital admissions for child injuries.
For health workers, important points when advising on child accident prevention are:

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 Offer practical advice, not just general education - e.g., advise about car seats or
home safety equipment.

 Use an evidence-based approach where possible and dispel myths - eg, some parents
wrongly believe that cooker guards and baby walkers are safe.

 Promoting safety does not require overprotection ('wrapping children in cotton wool')
- this would delay development and increase the risk of obesity.

 Promote sensible precautions in line with the child's level of development.

Safety advice for carers of young children
The NHS choices website provides clear guidance on preventing accidents in young children.
Key points covered are prevention of the following injuries:

Falls
Use stair gates until the child is aged 2; teach older children how to climb stairs but supervise
them (even 4-year-olds may need some help).
 If the gaps between banisters or balcony railings are more than 6.5 cm (2.5 in) wide,

cover them with boards or safety netting.
 Change your baby's nappy on the floor; don't leave your baby unattended on a bed, sofa

or changing table, even for a second.
 Don't put baby seats on tables (a baby's wriggling could tip it over the edge).
 Take care to avoid tripping when carrying a baby.
 Don't let children under the age of 5 sleep in the top of a bunk bed.
 Keep low furniture away from windows. Fit windows with safety catches (and ensure

adults know where the keys are kept in case of fire).
 Use a five-point harness with a highchair.
 Don't use a baby walker.

Choking, strangulation and suffocation

 Keep all ties and cords short (eg, on curtains, blinds and switches) to avoid a child
being strangled by the cord.

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 Do not tie or hang things to babies' cots, and keep all toy ribbons short.
 Cut food up small enough for a child's mouth; don't give young children hard food

such as boiled sweets or nuts.
 Don't leave children alone when eating; encourage them to sit still while they are

eating.
 Keep small objects such as coins and buttons away from babies and toddlers.
 Keep plastic bags out of reach.

Burns and scalds
 Put cold water in a bath before hot water, check the temperature carefully; consider

fitting thermostatic mixing valves.
 Keep hot drinks, teapots, matches, irons and hair straighteners out of reach.
 Use fireguards and spark guards.

Drowning

 Children can drown in a few inches of water; they must be supervised at all times
when bathing and near ponds, water containers or pools.

 Garden ponds or pools must be properly fenced.

Poisoning

 Keep chemicals and medicines out of sight and reach.
 Children can often open 'child-proof' containers.

Cuts and bumps
 Use safety glass in low doors/windows, or cover with safety film.
 Keep scissors, knives and razors out of children's reach.
 Cover sharp corners; use door stoppers to prevent trapped fingers.

Home safety

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 For general home safety advice, see 'Home accident prevention', below.

Car safety
 Use correct child seats.
 Put children in a rear seat of a car whenever possible.
 Do not put a rear-facing baby seat in a front car seat with an active airbag (forward-

facing seats in the same position, while not illegal, are also not ideal for toddlers).
 Never leave children alone in a car.

Outdoor safety
 Find safe places to play.
 Use a harness or hold hands with small children in the street.

Elderly or disabled people and accident prevention

Frailty and health problems make the elderly, particularly those over the age of 75, at
increased risk of accidents, usually occurring in the home. Falls are the most common cause.
Inability to get up after falling puts the person at risk of hypothermia and pressure sores. Hip
fractures after falls are a major cause of morbidity and mortality.
NICE and Clinical Knowledge Summaries (NICE CKS) have issued guidelines on the assessment
and prevention of falls in older people. They state that older people should be asked
routinely if they have fallen in the previous year. Those who have fallen, or those considered
at risk of falling, should have a multifactorial falls risk assessment and should be considered
for interventions, including those to improve their strength and balance and removal of any
home hazards.
Environmental interventions have a role in safety for disabled or elderly people living at
home - this has led to the concept of 'smart homes', which incorporate alarm or monitoring
devices and other safety features. However, safety for those needing home care has many
aspects; this includes not only physical safety but social and emotional well-being.

WSH Act: responsibilities of stakeholders

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The Workplace Safety and Health (WSH) Act defines the responsibilities for each stakeholder
group, such as employers, occupiers, employees and self-employed.

Employer

As an employer, you must protect the safety and health of your employees or workers
working under your direction, as well as persons who may be affected by their work.
You must:
 Conduct risk assessments to identify hazards and implement effective risk control

measures.
 Make sure the work environment is safe.
 Make sure adequate safety measures are taken for any machinery, equipment, plant,

article or process used at the workplace.
 Develop and implement systems for dealing with emergencies.
 Ensure workers are provided with sufficient instruction, training and supervision so

that they can work safely.

Principal
A principal is any person or organisation who engages another person or organisation to
supply labour or perform work under a contract for service.
As a principal, you must ensure that the contractor you engage:
 Is able to perform the work they are engaged for.
 Has made sure that any machinery, equipment, plant, article or process that is used at

work is safe.
However, if you instruct the contractor or the workers on how the work is to be carried out,
your duties will include the duties of an employer.

Occupier

In workplaces registered or notified as a factory, the occupier is the person who holds the
certificate of registration. In all other workplaces, the occupier is the person who has control
of the premises, regardless of whether they are the owner of those premises.

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As an occupier, you must ensure that the following are safe:
 The workplace.
 All pathways to and from the place of work.
 Machinery, equipment, plants, articles and substances.
You must ensure that the above does not pose a risk to anyone within your premises, even if
the person is not your employee.
You may also be responsible for the common areas used by your employees and contractors.
Common areas include the following:
 Electric generators and motors.
 Hoists and lifts, lifting gears, lifting appliances and lifting machines.
 Entrances and exits.
 Machinery and plants.

Manufacturer or supplier

As a manufacturer or supplier, you must ensure that any machinery and
equipment or hazardous substances you provide are safe.
You must:
 Provide information on health hazards and how to safely use the machinery,

equipment or hazardous substance.
 Examine and test the machinery, equipment or hazardous substance to ensure that it

is safe for use.
 Provide results of any examinations or tests of the machinery, equipment or

hazardous substances.

Installer or erector of machinery

You must ensure that the machinery and equipment that you have erected, installed or
modified is safe and without safety or health risks when properly used.

Employee

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As an employee, you must:
 Follow the workplace safety and health system, safe work procedures or safety rules

implemented at the workplace.
 Not engage in any unsafe or negligent act that may endanger yourself or others

working around you.
 Use personal protective equipment provided to you to ensure your safety while

working. You must not tamper with or misuse the equipment.
Self-employed
You are required to take measures to ensure the safety and health of anyone in the
workplace who may be affected by your work.

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FORMATIVE ASSESEMENT - NINE
 IAC0901 Given a list of stakeholders accurately indicate what each of them must do to

prevent accidents and incidents (Weight: 100%)

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BIBLIOGRAPHY
American Society of Safety Engineers.(2002) Scope and Functions of the Professional Safety Position.
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DeReamer, R.1980.Modern Safety and Health Technology. New York: Wiley & Sons, Inc.
Grimaldi, J.V. and Simmons, R.H.1975.Safety Management.3rd ed. Homewood, IL: Richard D. Irwin, Inc.
National Safety Council. Injury Facts, 2001 edition; 1998 edition.Italsca, IL: Author
Samuel Pepys Diary Home Page.2002. http://www.pepys.infor/fire.html.
OSHA Training Institute.1994.A Guide to Voluntary Compliance in Safety and Health. Atlanta, GA: Author

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