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Workplace Incident & Accident Reporting

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Ensures workplace incidents and injuries are reported, recorded, investigated, and escalated to OSHA when required.

29 CFR 190429 CFR 1904.39

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Immediate Response

Was medical care provided and the scene made safe? *
Date and time the incident occurred: *
Was the area secured to preserve evidence for investigation? *
Were affected personnel and supervisors notified? *

Incident Details

Description of what happened: *
Type of incident: *
Were there injuries requiring medical treatment beyond first aid? *
Names of persons involved and witnesses: *

OSHA Recording & Reporting

Was the case evaluated for OSHA 300 Log recordability within 7 calendar days? *
Did the event cause a fatality, in-patient hospitalization, amputation, or loss of an eye? *
If a fatality, was OSHA notified within 8 hours? *
If hospitalization/amputation/eye loss, was OSHA notified within 24 hours? *

Investigation & Root Cause

Was a root cause analysis performed (not stopping at 'employee error')? *
Were contributing factors (equipment, procedures, environment, training) identified? *
Were similar hazards elsewhere in the operation checked? *

Corrective Action & Closure

Are corrective actions defined with owners and due dates? *
Have corrective actions been verified as effective? *
Reviewer sign-off: *

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