Using the causal analysis section of an incident report form,

Using the causal analysis section of an incident report form, included in Course Documents and attached to this assignment, select a FACE report from those in the week 5 folder entitled FACE reports. After reading the report complete the causal analysis on this incident. Answer the following challenge questions on a separate word document. 1. What topics and corresponding standards or laws did you reference in determining what substandard conditions applied or were specific to this incident? 2. List a three questions that would be answered in helping to determine what personal factors were influential to the injured and involved persons. 3. In producing a countermeasure plan for the incident, what efforts are based upon the root causes of this incident? Causal Analysis Worksheet​IC#​Page: of Incident with Injury □ Incident without Injury □ Death □ Medical Treatment □ First Aid □ Illness □ Condition □ Crime against person □ Exposure □ Near Miss □ Incidental Spill □ Property Loss □ Crime against property □ Security Breach □ Equipment/Machine Failure □ Unplanned Release □ WORKSTATION: NAME______________ Environmental Conditions:(circle) Indoor or Outdoor Temp. _____ WBGT. ____ Wind Speed____ User Satisfaction Score: / 360 Safety Efficiency: total: ___/ 18 Behavior Based Composite Score: ___________ Hazard Recognition Accuracy/Level 1 Hazards: ________ General Description:(circle) rain snow ice icy wet dry cloudy sunny windy fog dusty Lighting: (circle) dawn daylight dusk dark- outside lighting on indoor plant lighting on dark- outside lighting off indoor plant lighting off dark- outside lighting inop indoor plant lighting inop Noise Rating: Action Level □ Below Action Level □ Below Latest Usability Assessment Attached: Yes □ No □ Constant Environmental Conditions: o Indoor o Windy Notes:/Other: o Outdoor o Fog o Debris on ground/floor o Dusty o Rain o Dawn Noise Rating: o Snow o Day o Ice o Night o Wet o Temperature . o Dry o Lights turned on o Cloudy o Lights turned off o Sunny o Lights inoperable Glare: □ ____________________________________________________________________________________________ CHAIN OF EVENTS: Number Description Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ Event #: Concurrent Step □ #____ • Copy and Use additional Chain of Event Sheet if necessary Risk Assessment Risk from Employment: Yes□ No□ Risk Personal to Injured: Yes□ No□ Employment Risk Factors: □ Height □ Exertion □ Surface □ Motion □ Confined Area □ Congested Area □ Noise □ Heat/Cold □ Weather □ Other: _________________________ Personal Risk Factors: □ Medical □ Mental □ Failed to take medication □ Balance Condition □ Hearing □ Eyesight □ Previous Injury □ Other:______________________ Probability: High□ (3) Medium□ (2) Low□ (1) Experience: Routine Occurrence □ (3) Occasional Occurrence □ (2) Rare Occurrence □ (1) Exposure: Several Persons □ (3) Few Persons □ (2) Single Person □ (1) Risk Rating Total: Incident Map: (map the events of the incident in chronological order; place causes beneath each event) (Add additional pages if necessary; Orient page to portrait/landscape) (Students: Hand Draw, scan or take digital photo and re-attach) Immediate Cause Common Unsafe Acts: Failure to Wear PPE; Failure to Wear PPE Properly; Failure to Follow Policy/Procedure; Failure to Recognize Hazard; Failure to Enact Control; Enabling Safety device/control; Use of inoperable equipment; Improper lifting; Failure to use tools/equipment properly; Intentional act/horseplay; if other specify Involved Person Unsafe Act(s) Event from Map Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Common Substandard Conditions: Improper guarding; Inoperable/Inadequate Safety Control; Defective tools/accessories/materials; General housekeeping; STF hazards; Exposure above acceptable level (noise, temp, light, radiation, ventilation, dust, substance); Fire hazards; Accessibility conditions; if other-specify. Equipment/Machine/Process Substandard Condition Event from Map Name: Standard: Location: Name: Standard: Location: Name: Standard: Location: Name: Standard: Location: Name: Standard: Location: Name: Standard: Location: (Add additional page if necessary) Basic Cause Job Factors: Inadequate equipment; Harsh weather; On slope; Congested area; Complex work; High physical demand; Repetitive action; Schedule; Indoor; Outdoor; Daylight; Dark; Normal Hours; Off peak hours; If other specify. Job Factors are conditions of operation other than those prohibited by standard/policy. Job Factors Event from Map Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Personal Factors: Stressed from life events; Inexperience; Untrained; Impaired(substance); Fatigued; Motivation; Deliberate Risk; Euphoria; Hurry; Frustration Involved Person Personal Factor(s) Event from Map Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ Name: Witness □ Injured □ Focus □ Other □ Mgt □ Supervisor □ (Add additional page if necessary) Root Cause Root Causes are management system failures or oversights Organizational Errors Objectives o Inadequate Objectives o Inadequate standards of performance o Inadequate analysis/measurements Organization o Inadequate chain of command o Lack of competency o Over delegation o Lack of delegation Operations o Improper layout o Lack of policy/Scope o Lack of resources o Procurement Issues o Scheduling o Lack of procedural development o Lack of Environmental Planning Operational Errors Conduct o Sets poor example o Sets poor example o Supervisor o Manager Responsibility o Instructions not understood o Instructions not accepted o Pressure of immediate task obscures o Out of scope of responsibility o Supervisor o Manager Authority o Fails to make decision o Failed to delegate o Out of scope of competency o Out of scope of Authority o Supervisor o Manager Rules/Procedures o Fails to enforce o Fails to follow up o Uneven enforcement o Supervisor o Manager Coaching o Fails to explain why o Failed to listen o Failed to coach o Inadequate instructions o Supervisor o Manager Morale o Tension with labor o Not confident o Lacks motivation to labor force o Supervisor o Manager Operations o Improper job placement o Lack of equipment to worker o Inefficient workloads/flow o Supervisor o Manager Root Cause Consequence Event from Map Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ Entire Incident □ (Add additional page if necessary) Root Examination Had hazard been previously reported and corrected Yes □ No □ N/A □ Was the task covered in a JHA Yes □ No □ N/A □ Involved persons trained: ___/____/_____ Yes □ No □ N/A □ Did training include specific knowledge Yes □ No □ N/A □ Did policy cover situation Yes □ No □ N/A □ Training update ordered Yes □ No □ N/A □ Policy update ordered Yes □ No □ N/A □ Cross functional committee review ordered Yes □ No □ N/A □ Cultural Examination: (rate from 1 to 5; 5 being highest positive outcome) The causes reflect a positive indication to the cultural criteria: Workforce Associate (1-5) Cultural Criteria Management (1-5) • Participation • Commitment • Attitudes • Perceptions • Competency • Compliance

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