SaskPower
OHSAS 18001 Documentation
Incident Management Process (IMP)
1.0
PURPOSE
SaskPower has developed and implemented a process to investigate the facts and circumstances of
incidents and dangerous occurrences to determine root causes and develop and communicate actions to
prevent recurrence.
The Incident Management Process (IMP) is designed to:
•
•
•
•
•
Ensure Employees are capable of recognizing and acknowledging when an incident has
occurred.
Encourage notification of all incidents, and take remedial action to prevent further loss, with the
understanding that investigations are completed to identify facts not place blame.
Ensure a thorough, consistent investigation of all incidents, to identify root causes, which permit
the development and implementation of appropriate corrective and preventative measures,
eliminating the potential for recurrence and to prevent recurrence through the development of
controls or actions that address the determined root causes.
Develop and implement investigation processes and activities directed at identifying the facts and
root causes.
Meet Occupational Health and Safety legislative requirements.
2.0
DEFINITIONS
2.1
Dangerous Occurrence
Any occurrence that does not, but could have resulted in, a condition or circumstance set out in
clause 8(1) of the Occupational Health and Safety Regulations, and includes: a) the structural
failure or collapse of i) a structure, scaffold, temporary false work or concrete formwork; or ii)all or
any part of an excavated shaft, tunnel, caisson, coffer dam, trench or excavation; b) the failure of
a crane or hoist or the overturning of a crane or unit of powered mobile equipment; c) an
accidental contact with an energized electrical conductor; d) the bursting of a grinding wheel; e)
an uncontrolled spill or escape of a toxic, corrosive or explosive substance; f) a premature
detonation or accidental detonation of explosives; g) the failure of an elevated or suspended
platform; and h) the failure of an atmosphere-supplying respirator. Refer to Appendix 1 IMP
Reference Chart for list of conditions or circumstances.
2.2
Emergency
A present or imminent event that requires prompt coordination of actions or special regulation of
persons or property to protect the health, safety, or welfare of people, or to limit damage to
property and the environment.
2.3
First Aid (FA)
The initial and immediate assistance given for illness or injury with minimal or no medical
equipment. The purpose of first-aid is to minimize injury and/or disability until definitive medical
treatment can be accessed.
2.4
Incident
An occurrence that did, or could have, resulted in injury, damage or loss as determined by the
SaskPower Incident Reference Chart.
1 of 21
SaskPower
OHSAS 18001 Documentation
2.5
Investigation
Is an analysis of all incidents with the intent of establishing root cause and corrective/preventive
measures.
2.6
Lost Time Injury (LTI)
An injury that required medical attention and day(s) are lost following the day of the injury.
2.7
Medical Treatment Case (MTC)
An injury that requires medical attention in accordance with CEA Standards, but no day(s) is lost
other than the day of the injury.
NOTE: CEA defines medical treatment as the management and care of a patient to combat
disease or disorder. Medical treatment does not include:
•
•
•
2.8
Visits to a licensed health care professional solely for observation or counseling;
Diagnostic procedures; or
First aid.
Near Miss
An incident that could have, but did not, result in unintended harm or damage.
2.9
Serious Injury
An injury that causes or may cause the death of a worker or will require a worker to be admitted
into a hospital as an in-patient for a period of 72 hours or more.
3.0
APPLICATION / EXCEPTIONS
This Incident Management Process applies to all SaskPower facilities/operations, and employees,
contractors and visitors. There are no exceptions to SaskPowers Incident Reporting Management
Process.
4.0
ROLES AND RESPONSIBILITIES
4.1
Executive / Managers shall:
•
•
•
•
4.2
Monitor the Incident Reporting and Investigation process for their respective areas of
responsibility.
Allocate technical resources to the investigation process where applicable.
Cooperate, stay informed and provide resources from respective areas to increase effectiveness
of investigation.
Allocate resources to ensure the implementation of incident corrective/preventive actions
Out-of Scope Supervisors shall:
•
•
Ensure medical assistance has been provided or initiated;
Ensure medical assistance has been provided or initiated;
2 of 21
SaskPower
OHSAS 18001 Documentation
•
•
•
•
•
•
4.3
• Ensure medical assistance has been provided or initiated;
• Ensure medical assistance has been provided or initiated;
• Ensure medical assistance has been provided or initiated;
• Ensure medical assistance has been provided or initiated;
• Ensure medical assistance has been provided or initiated;
Ensure appropriate communications have taken place as per the Incident Reference Chart.
Ensure Employee Family Assistance Program has been provided or intiated as required.
Ensure the required information is entered into the incident reporting module of the Safety
Software for employee and contractor incidents.
Participate and fully cooperate in the Incident Investigation.
Evaluate and cooperate in recommendations stemming from the incident investigation and initiate
corrective or preventative actions are required.
Ensure corrective and preventative actions have been followed in accordance with
recommendations from the investigation and audit findings.
In-Scope Supervisors shall:
•
•
•
•
4.4
Ensure medical assistance has been provided or initiated;
Determine site control requirements and initiate them.
Notify the management supervisor or designate of all incidents as soon as possible
Ensure the incidents are documented in the incident reporting module of the Safety Software
Occupational Health Committees (OHC) shall:
•
•
•
4.5
Be advised of all injuries and fatalities as required by OH&S legislation and participate in
investigations when required
Participate in other investigations at the request of the supervisor or as defined in the local OHC
Terms of Reference;
Have access to all incident reports and investigations for all incidents
Employee shall:
•
•
•
4.6
•
•
•
4.7
•
•
•
•
•
•
•
Report all incidents are reported in accordance with the Incident Reference Chart.
Assist with the completion of the incident report form.
Cooperate and participate during the incident investigation as required.
Contractors shall:
Report all incidents to their contract administrator
Investigate all incidents as required and make results available to SaskPower contract
administrators upon request
Refer to the Contractor Health and Safety Management Program.
Corporate Safety shall:
Provide centralized leadership to the incident response and investigation
Maintain the Incident Reporting and Investigation Policy and support documentation of policy
Provide administrative and technical support to the application of the incident investigation
process as required
Facilitate the development of Corporate corrective/preventive action plans as required.
Demonstrate that the effectiveness of the corrective and preventative actions are monitored.
Communicate information and findings through information bulletins
Ensure that serious injuries, fatalities and dangerous occurrences are reported to the Ministry of
Labour Relations and Workplace Safety
3 of 21
SaskPower
OHSAS 18001 Documentation
•
•
4.8
Communications and Public Affairs
•
5.0
Conduct audits to ensure conformance.
Provide centralized distribution of incident statistics and related key indicators, and conduct
regular trending and analysis.
Responsible to lead media contacts as required.
METHOD / PRACTICE
All incidents shall be communicated and investigated within the timelines specified in the Incident
Management Process Reference Chart Appendix 1 and the Incident Management Process Flowchart
Appendix 2.
Incident investigation shall determine the facts of the incident, identify root cause(s) and make
recommendations to prevent recurrence. Recommendations shall be tracked in the safety software. This
shall include identifying responsible parties, resources required to complete and due dates.
Incidents shall be reported to Corporate Safety, Management, and the Ministry of Labour Relations and
Workplace Safety by the Safety Coordinator. Executive will be notified by the Chief Safety Officer.
Incident reports and corrective/preventive actions shall be monitored through Safety Coordinators’
monthly reports. The Safety Coordinators will provide briefings at SMS/management meetings. Reports
shall be available in the incident reporting module of the Safety Software.
Incidents and corrective/preventive actions shall be communicated to applicable staff.
Incident Management Process
To be successful in preventing recurrences and reducing incidents, the following six step processes shall
be followed:
4 of 21
SaskPower
OHSAS 18001 Documentation
5.1
Response
Recognize that an incident has occurred.
Complete an initial assessment of the incident to determine the following:
•
•
•
What has occurred;
Who was involved; and
What is required to control the scene?
Determine if emergency response is required
If the incident is an “emergency”, follow the local Emergency Response Plan. If the incident does not
meet the definition of an “emergency” continue following the Incident Management Process.
Prevent further loss by determining and implementing immediate corrective action.
Do not disturb the incident scene more than is necessary to safely remove injured personnel and shut
down equipment still in operation.
Secure the incident scene to:
•
•
•
5.2
Prevent further incident(s);
Locate and preserve evidence; and
Meet legislative requirements.
Notification and Initial Reporting
Verbally notify appropriate individuals of the incident occurrence based on incident type and severity.
(Refer to Appendix 1 Incident Management Process Reference Chart for more information).
Regardless of incident severity, employees must verbally notify their direct supervisor or designate
immediately as practical.
If the incident is critical, or may attract the attention of the media, notify Communications and Public
Affairs, as per the local emergency response procedures.
The supervisor shall refer to Appendix 1 Incident Management Process Reference Chart and notify
support departments as applicable.
Following verbal notification of the incident occurrence, an initial report will be entered into safety software
by the employee, or designate. Electronic notifications will supplement the verbal notifications referenced
in the Incident Management Process Reference Chart – Appendix 1 and Incident Management Process
Flow Chart - Appendix 2.
5.3
Investigation
Investigation Tools & Equipment
Investigation kits shall be assembled, maintained, located in a centralized area, and accessible to all
supervisors, the Safety Coordinator and the Occupational Health Committee (OHC).
Investigation kits shall contain the following, but not limited to:
5 of 21
SaskPower
OHSAS 18001 Documentation
•
•
•
•
•
•
•
•
Incident Classification And Notification
Guide
Incident Management Process Forms
Local Emergency Management Plan
Personal Protective Equipment
Disposable 35 MM Camera
Clipboard, Paper, Ruler And Pencils
Graph Paper (For Diagrams)
Tape Measure (100' / 30 M)
• Identification Tags (For Parts)
•
•
•
•
•
•
•
High-Visibility Tape Or Cord
High Visibility Traffic Vest
Hazard Triangles
Yellow Chalk
Large Plastic Bags For Gathering Evidence
Flashlight
List of Drug and Alcohol Testing Locations
and Contact Information
Conduct Initial Assessment of Incident
Gather evidence to assist in determining cause(s) of the incident such as the following:
•
•
•
•
•
•
Diagrams;
Maps;
Photographs;
Measurements;
Videos, and
Plot / site plans, etc.
Note: All attachment information (i.e. photos, sketches, videos) shall be dated and referenced as an
attachment.
Note: Where reasonable grounds have been established to determine that drugs or alcohol may have
been a contributing factor, and where the employee has denied use, the lead investigator will require a
test, with approval from the appropriate supervisor, arrange for transportation for the employee to a
testing location and inform the Return to Work department.
Record details immediately as the incident site may be subject to rapid change or destruction. Include
details such as:
•
•
•
•
•
•
•
•
•
•
Potential witnesses (i.e. contact information);
Law enforcement (if applicable);
Position of injured (i.e. worker, public);
Position of equipment (i.e. hoists, vehicles);
Position of materials (i.e. chemicals, loads);
Preventative devices in use (i.e. guards);
Ergonomic conditions (i.e. lighting levels, position of machinery controls);
Environmental conditions (i.e. weather conditions); and/or
Housekeeping (i.e. debris).
Physical evidence of drug or alcohol paraphernalia
Document an initial sequence of events. The initial sequence of events should be compiled immediately
so as to minimize confusion of the facts.
Determine Investigation Resources and Establish Investigation Team (if required)
Resources required for the investigation are assigned based on the incident category, event type and
severity (Minor, Significant, Major, or Critical). Keep the investigation team led by Corporate Safety, to a
manageable size and include those personnel who will add value to the process.
6 of 21
SaskPower
OHSAS 18001 Documentation
A member of the Occupational Health Committee shall sit as a member of the investigation team for all
incidents classified as “Critical”, or as directed by local management. Incident summary reviews for all
incidents shall reside as a standing agenda item for all OHC and local meetings.
Assign roles / tasks to each person involved in the team (i.e. contact person, leader, etc.) The lead
investigator will be a designate from Corporate Safety.
Provide the investigation team with the appropriate tools as outlined above.
Critical Incidents with a high potential for harm or highly technical contributing factors may require the
Chief Safety Officer, in consultation with senior management, to appoint a Critical Incident Investigation
Team (CIIT). The CIIT will be selected for their technical abilities and knowledge of the system and
apparatus. The CIIT investigation is intended to compliment any mandated OHC investigations.
Obtain and Evaluate Data
Put all those involved at ease.
•
Evidence collected may include documents, interviews, written statements, photographic evidence,
physical evidence, technical analysis and drug and alcohol records.
•
Discuss with the individuals involved that the intent of the investigation is to prevent recurrence of
similar incidents by determining cause(s) and that the investigation focuses on the facts to determine
corrective and preventative actions.
•
The assignment of blame and disciplinary action should not be associated with an incident
investigation. These issues have to be dealt with, but should be done separately from the
investigation process. The SaskPower Performance Management Process shall be used for
disciplinary situations.
Review the preliminary documentation and ensure the initial incident assessment details are recorded
(i.e. positions of injured workers, where objects are in relation to each other, the angle something came
from or the force behind an object).
Interview witnesses
•
Talk with everyone who was in the area at the time of the incident, or just before, or just after the
incident occurred.. This includes eyewitnesses, individuals involved, or others such as individuals
familiar with the work practices, procedures or work area.
TIP: Questions to ask the witnesses will vary depending on the circumstances of the incident. However,
there are six basic questions you should include in any interview:
•
•
•
•
•
•
Who was injured?
What were the materials, machines, equipment or conditions involved?
When did it happen?
Where did it happen?
Why did it occur?
How did the incident happen?
TIP: Use the following techniques to help your interview be more effective:
•
•
Conduct the interview at the scene;
Interview individuals separately in a private area;
7 of 21
SaskPower
OHSAS 18001 Documentation
•
•
•
•
•
•
•
Keep the interview positive;
Ask open-ended questions (do not lead the questions);
Do not talk down to the person or rush them to answer quickly;
Paraphrase what people tell you to make sure you understand;
Watch for clues from the person’s body language;
Record a statement for each witness, have them sign it, and give them a copy as soon as possible;
and
Thank the person, and ask them to come back to you if they think of anything else.
TIP: Separating fact from opinion and circumstantial evidence is a vital component of information
gathering. To do this, divide the data into the following categories:
•
Factual Evidence: Data that usually cannot be disputed. This includes information such as the time of
day, the location of the incident, logs and printouts, and written reports or photographs illustrating the
condition and position of physical evidence. This requires that the investigators can clearly establish
that the evidence was neither moved nor tampered with.
•
Witness Statements/Description of Events: Declarations from witnesses who actually saw the incident
happen, or from people who came upon the scene.
•
Circumstantial Evidence: A logical interpretation of facts that may lead to an unproved conclusion.
Avoid the temptation to draw conclusions based on this type of evidence.
•
Investigators must understand that the accuracy and thoroughness with which they obtain and record
data and information will, to a great extent, determine the quality of the final report. It will also
determine the effectiveness of the remedial actions.
Evaluate historical data.
•
Obtain relevant information from analysis of the conditions at the time of the incident, or from prior
records such as technical data sheets, maintenance reports, past incident reports, training reports,
work schedules, planning schedules, work practices and procedures, etc.
Define sequence of events.
•
Determine the chronological order of the events. Include relevant events that occurred 48 hours prior
to the incident and following the incident.
Complete Cause Analysis
Where drugs or alcohol are a known or suspected cause, refer to the Drug and Alcohol Process and
Testing Protocols for guidance.
Identify the conditions that describe the circumstances relative to each event.
Identify which of the conditions became a cause. Causes are often described as the substandard
practices and conditions that precede the event. If there are too many conditions identified for a particular
event, it needs to be broken down into several discrete events.
One of the simplest and most effective methods of Multiple Cause Determination is to use the
Effect/Cause Analysis process.
•
•
Ask “Why”.
Continue to ask “Why”.
8 of 21
SaskPower
OHSAS 18001 Documentation
•
Determine causes until you reach the point where if specific action is taken the incident will not recur.
EFFECT
WHY?
CAUSE
Injury
Fall
Fall
Slick Surface
Slick Surface
Water
Inadequate Drainage
EFFECT
WHY?
CAUSE
Inadequate Drainage
Plugged Drain
Plugged Drain
Barrel Over Drain
Barrel Over Drain
Constricted Work Space
Constricted Work Space
3.2 – Inadequate Design Specification
EFFECT
WHY?
CAUSE
Water
Leaky Valve
Leaky Valve
Inadequate Maintenance
Inadequate Maintenance
4.1 – Inadequate Work Planning
There are a number of other tools and techniques available to assist in identifying root cause (i.e. Fault
Tree Analysis, etc.). Contact your Safety Coordinator for further assistance.
Develop Recommendations for Corrective Action Plans
Once cause(s) have been determined, appropriate corrective and preventative actions can be identified
and implemented so similar incidents do not recur. Recommendations should address each cause and
can be of two types:
•
Interim Actions are ones that should be taken immediately to reduce the hazards. These “stop gap”
measures are usually ones that have been recommended by the Investigation team or steps
implemented at the time the incident occurred. They are extremely important because they reduce
the hazard potential immediately.
•
Corrective / Preventative Actions are permanent solutions and may require more time to accomplish.
Corrective and preventative actions must address each cause. Implementation and follow up of
these permanent measures are essential and may require input and consultation from other groups
such as senior management, Legal, etc.
Ensure each recommendation specifically describes the action to be taken, and is defined in clear and
measurable terms. Recommendations should be practical and achievable and eliminate or decrease risk
or consequences.
9 of 21
SaskPower
OHSAS 18001 Documentation
Recommendations must be assigned to a person, by name not position, for completion by an identified
date. Recommendations can only be assigned to Investigation Team Members. Prior to assigning
accountability outside the investigation team, a team member must review the Corrective Action Plan
(CAP) with the identified personnel.
In some situations, recommendations will require further analysis to determine their potential
effectiveness. Refer to the Hazard & Risk Assessment Standard to address the risk in terms of the
probability of the incident recurring and its potential severity.
Recommendations for control generally fall into the following four categories:
• Substitution;
• Engineering controls;
• Administrative controls, and / or
• Personal protective equipment.
To complete further analysis, consult with the appropriate technical experts (i.e. Safety Coordinator
and/or SMS Specialist).
5.4
Reporting
Once all the initial information has been collected and interpreted, it must be documented on the Initial
Incident Report Form in the safety software. Detailed investigation reports and support documents will be
attached to the initial incident report.
Corrective Action Plans will be tracked to completion in accordance with the Corrective Action Plan (CAP)
section of the report form, which is designed to:
•
•
•
•
Identify and notify individuals accountable for CAP implementation;
Assign responsibility to individuals to action specific items;
Track implementation progress by providing status updates on targeted completion dates; and
Confirm the incident has been managed until all actions are completed.
Communication and reporting to the Saskatchewan Occupational Health and Safety Division and / or to
the Workers Compensation Board via W1 forms may be necessary.
Refer to Appendix 1 – Incident Management Process Reference Chart for information on reporting
requirements by incident type.
5.5
Information Distribution
Information identified and documented throughout the management of the incident may assist others
(internal or external) in preventing similar incidents from recurring.
SaskPower employees, contractors and external parties may learn from incidents and prevent recurrence
in the future. Corporate Safety personnel are accountable for communicating appropriate incident
findings and corrective action.
6.0
TRAINING REQUIREMENTS AND MATERIAL
Those staff responsible for the implementation and maintenance of the Incident Management Process
shall be trained in the requirements outlined in this Process. Reference SaskPower Safety Training
Management Process for full details.
10 of 21
SaskPower
OHSAS 18001 Documentation
7.0
RESOURCES
For more information regarding the Incident Management Process, you should contact your local Safety
Coordinator.
8.0 ATTACHMENTS
Appendix 1 - IMP Reference Chart
Appendix 2 - IMP Flow Chart
Appendix 3 - IMP Forms
Appendix 4 - IMP Communication Guide
9.0
REFERENCES
The legal requirements for incident management are outlined in the statutes / regulations of the
jurisdiction having authority:
• Saskatchewan Occupational Health and Safety Regulations, 1996.
• SaskPower (located on SafetyNet)
o Incident Reporting and Investigation Policy
o Incident Reporting and Investigation Standard
11 of 21
OHSAS 18001 Documentation
SaskPower
Appendix 1 – IMP Reference Chart
12 of 21
SaskPower
Appendix 2 – IMP Flow Chart
OHSAS 18001 Documentation
Recognize That An Incident Has Occurred.
Incident Occurs
•
Complete an initial assessment of the incident to determine the
following:
 What has occurred;
 Who was involved; and
 What is required to control the scene?
Determine If Emergency Response Is Required.
•
Incident
Response
Incident
Communication
Prevent Further Loss By Determining And Implementing Immediate
Corrective Action.
•
Do not disturb the incident scene more than is necessary to safely
remove injured personnel and shut down equipment still in operation.
Verbally Notify Appropriate Individuals Of The Incident Occurrence
Based On Incident Type And Severity.
•
•
•
Incident
Investigation
If the incident is an “emergency”, follow local Emergency Response
Plans.
Regardless of incident severity, employees must verbally notify their
Direct Supervisor immediately.
If the incident is Critical, or may attract the attention of the media, notify
Communications and Public Affairs.
Following verbal notification of the incident occurrence, an initial report
will be entered into SafetyNet Incident Reporting by the employee, or
designate.
Conduct Initial Assessment Of Incident.
•
•
•
Gather evidence to assist in determining cause(s) of the incident. All
attachment information (i.e. photos, sketches, videos) shall be dated
and referenced as an attachment.
Record details immediately as the incident site may be subject to rapid
change or destruction.
Document an initial sequence of events.
Determine Investigation Resources And Establish Investigation Team
•
•
•
The supervisor accountable for incident selects resources required for
the investigation based on incident category, event type and severity.
A member of the Occupational Health Committee shall sit as a member
of the investigation team for all incidents of “Critical” or as determined
by local management.
Assign roles / tasks to each person involved in the team (i.e. contact
person, leader, etc.) Designate a lead investigator to co-ordinate the
investigation.
13 of 21
SaskPower
Appendix 2 – IMP Flow Chart
OHSAS 18001 Documentation
Obtain And Evaluate Data.
•
•
•
•
Put all those involved at ease.
 Discuss with the individuals involved that the intent of the
investigation is to prevent recurrence of similar incidents by
determining cause(s) and that the investigation focuses on the facts
to determine corrective and preventative actions.
Review the preliminary documentation.
 Ensure the initial incident assessment details are recorded (i.e.
positions of injured workers, where objects are in relation to each
other, the angle something came from or the force behind an
object).
Interview witnesses.
 Talk with everyone who was in the area at the time of the incident,
or just before, or just after it happened.
This includes
eyewitnesses, individuals involved, or others such as individuals
familiar with the work practices, procedures or work area.
Evaluate historical data.
 Obtain relevant information from analysis of the conditions at the
time of the incident, or from prior records such as technical data
sheets, maintenance reports, past incident reports, training reports,
work schedules, planning schedules, work practices and
procedures, etc.
Define Sequence Of Events.
•
Determine the chronological order of the events. Include relevant
events that occurred 48 hours prior to the incident and following the
incident.
Complete Cause Analysis.
•
•
Identify the basic cause(s) that lead to the incident.
One of the simplest and most effective methods of Multiple Cause
Determination is to use the Effect/Cause Analysis process.
 Ask “Why”.
 Continue to ask “Why”.
 Determine causes until you reach the point where if specific action
is taken the incident will not recur
Develop Recommendations For Corrective Action Plans.
•
•
•
Once cause(s) have been determined, appropriate corrective and
preventative actions can be identified and implemented.
Recommendations must address each cause and can be of two types:
 Interim Actions are ones that are being taken immediately to reduce
the hazards.
 Corrective / Preventative Actions are permanent solutions and may
require more time to accomplish.
Ensure each recommendation specifically describes the action to be
taken, and is defined in clear and measurable terms.
Recommendations must be assigned to a person, by name not
14 of 21
SaskPower
Appendix 2 – IMP Flow Chart
OHSAS 18001 Documentation
•
Incident Report
Once All The Information Has Been Collected And Interpreted, It Must
Be Documented On The Incident Report Form In Intelex.
•
Incident
Information
position, for completion by an identified date.
Recommendations can only be assigned to Investigation Team
Members.
Corrective Action Plans will be tracked to completion in accordance
with the Corrective Action Plan (CAP) section of the report form, which
is designed to:
 Identify and notify individuals accountable for CAP implementation;
 Assign responsibility to individuals to action specific items;
 Track implementation progress by providing status updates on
targeted completion dates; and
 Confirm the incident has been managed until all actions are
completed.
Information Identified And Documented Throughout The Management
Of The Incident That May Assist Others (Internal Or External) In
Preventing Similar Incidents From Recurring Shall Be Shared As
Appropriate.
•
•
SaskPower employees, contractors and external parties may learn from
incidents and prevent recurrence in the future. Corporate Safety
personnel are accountable for communicating appropriate incident
findings and corrective action.
Notification and reporting to the Saskatchewan Occupational Health
and Safety Division and / or to the Workers Compensation Board via WI
forms maybe necessary dependent on incident type and severity.
15 of 21
SaskPower
Appendix 3 – IMP Forms
OHSAS 18001 Documentation
SaskPower Incident Initial Reporting Form
Reporting Information:
Date of Incident:
Time of Incident:
Record #:
SaskPower Incident Type: (Reference Incident Guide - Check all that apply)
Personal Incident
Motor Vehicle Incident
Property / Equipment Damage
Regulatory
Public
Incident Classification:
Near Miss:
Yes
No
SaskPower Incident Affiliation:
Company Incident
Incident Severity:
Minor
Significant
Major
Critical
Immediate Supervisor Name:
Employee Name:
Contractor Incident
Contract Employee Name:
Contractor Company:
Location Information:
Business Unit:
Incident Site / Location Description:
Incident Sequence Summary: (Brief factual description of incident. (Relevant events, in chronological order, that
happened prior to the incident, during the incident, and immediate actions that followed the incident. Identify who
(function, not name), what, when, where, why.)
16 of 21
SaskPower
Appendix 3 – IMP Forms
OHSAS 18001 Documentation
SaskPower Incident Supervisor Reporting Form
Reporting Information:
Date of Incident:
Time of Incident:
Record #:
SaskPower Incident Type: (Reference Incident Guide - Check all that apply)
Personal Incident
Motor Vehicle Incident
Property / Equipment Damage
Regulatory
Public
Incident Classification:
Near Miss:
Yes
No
Incident Severity:
SaskPower Incident Affiliation:
Company Incident
Minor
Significant
Major
Critical
Immediate Supervisor Name:
Employee Name:
Contractor Incident
Contract Employee Name:
Contractor Company:
Location Information:
Business Unit:
Incident Site / Location Description:
Incident Report Status:
Initial Incident Report
Detailed Report Required:
SaskPower Investigation Team:
Date Reported:
Yes
Date Completed:
No
Date Completed and Attached:
Team
Members
/Role:
Witness Information if required:
Witness Name:
Witness Name:
Telephone:
Telephone:
Incident Sequence Summary: (Brief factual description of incident. (Relevant events, in chronological order, that
happened prior to the incident, during the incident, and immediate actions that followed the incident. Identify who
(function, not name), what, when, where, why.)
17 of 21
SaskPower
Appendix 3 – IMP Forms
OHSAS 18001 Documentation
Injury / Illness Summary: (Complete this section only if this incident involved injury or illness)
Severity:
First Aid
Medical Treatment Case
Onsite First Aid Provider Name:
Restricted Work Case
Lost Time Injury
First Aid Provider Qualifications:
Fatality
Description of First Aid Treatment Provided:
Injured Party(s) Information:
Name
Employee
Employee
Affiliation
Contractor
Contractor
Public
Public
Employee
Contractor
Public
Body Location of Injury / Illness
Current Condition
Type of Injury:
Head
Burn
Neck
Cut
Torso
Sprain
Arm
Broken Bone
Hand
Soft Tissue Damage
Back
Exposure
Leg
Twist
Foot
Dislocation
Other:
Other:
SaskPower Motor Vehicle Incident Summary: (Complete this section only if a SaskPower or Contractor Vehicle is Involved)
Location:
Roadbed Surface Type:
Police File #
Asphalt
Gravel
Service Order#
Concrete
Dirt
Light Conditions:
Darkness
Daylight
Dusk
Road Conditions:
Dry
Wet
Covered w/ snow
Covered w/ ice
Weather Conditions:
Clear
Sunny
Raining
Foggy
Vehicle & Driver Information – Vehicle #1 – SaskPower Vehicle
Driver Name:
Occupation:
Dawn
Cloudy
Snowing
SaskPower Contractor Vehicle
Drivers License # & Province:
Drivers License Class:
Years of Driving Experience:
Last Defensive Driving Course: (yyyy/mm/dd)
Unit No:
License Plate #:
Serial No:
Speed: (kms/hr)
Speed Limit: (kms/hr)
Seat Belts Worn:
Year:
Yes
No
Make/Model:
Charges Laid:
Yes
Direction of Travel:
No
Charge Description:
Description of Damage: (Attach photo to file)
Repair Estimate:
Vehicle & Driver Information – Vehicle #2 Driver Name & Company:
Public
Utility
Contractor
License Plate # , Drivers License # & Province:
Vehicle Make, Model and Year:
Description of Damage &Estimate:
18 of 21
SaskPower
Appendix 3 – IMP Forms
OHSAS 18001 Documentation
Property Damage Summary: (Complete this section only if this incident involved damage to SaskPower Property)
Description of Property Damage:
Repair Estimate:
Public Property Damage Summary: (Complete this section only if this incident involved Public Property Damage by SaskPower)
Description of Public Party Damage:
Repair Estimate:
Name:
Address:
Telephone #:
Insurance Company:
Insurance Company Address:
Insurance Policy #:
Insurance Company Telephone
#:
Cause Analysis Table: (Check all that apply)
Job Factors
1. Codes/Practices/Procedures
1.1 Not developed
1.2 Inadequate code, practice or procedure
1.3 Code, practice or procedure not followed
1.4 Inadequate communication of
code, practice or procedure
1.5 Inadequate assessment of risk
1.6 Not implemented
2.
Tools and Equipment
2.1 Inadequate availability
2.2 Defective
2.3 Inadequate maintenance
2.4 Inadequate inspection
2.5 Tool used incorrectly
2.6 Inadequate assessment of tools for
task
3.
Design
3.1 Inadequate hazard assessment
3.2 Inadequate design specification
3.3 Design process not followed
3.4 Inadequate assessment of
ergonomic impact
3.5 Inadequate assessment of
operational capabilities
3.6 Inadequate programming
Systemic / Management Factors
4.
Planning
5.
4.1 Inadequate work planning
4.2 Inadequate management of change
4.3 Conflicting planning
4.4 Inadequate assessment of needs & risks
4.5 Inadequate documentation
Communication
5.1 Unclear roles, responsibilities, and
accountabilities
5. 2 Lack of communications
5.3 Inadequate direction/information
5.4 Misunderstood communications
6.
Personal Factors
7.
Capabilities
7.1 Limited physical capabilities (height,
strength, size, weight, reach, etc.)
7.2 Sensitivity to sensory extremes (sight,
sound, sense of smell, balance, touch)
7.3 Substance sensitivities / allergies
8.
Knowledge/Skill
6.1 Inadequate training/orientation
6.2 Training need not identified
6.3 Lack of coaching
6.4 Failure to recognize hazard
6.5 Inadequate assessment of needs
& risks
Natural Factors
Judgment
8.1 Preoccupied and unable to address
recognized hazard
8.2 Conflicting demands/priorities
8.3 Emotional stress
8.4 Fatigue
8.5 Criminal intent
8.6 Extreme judgment demands
8.7 Substance abuse
9.
Natural Factors
9.1 Fires
9.2 Flood
9.3 Extreme weather
9.4 Other
Cause Analysis:
Cause (i.e. 2.2)
Cause Explanation (i.e. Steering axle had metallurgical flaw)
19 of 21
SaskPower
Appendix 3 – IMP Forms
OHSAS 18001 Documentation
Interim Action Plan: (Immediate action taken to control the incident scene)
Action Taken
Accountability
Corrective Action Plan: (Long term action taken to control the incident scene)
Action Planned or Taken
Accountability
Target Date
(yyyy/mm/dd)
Complete
Date
(yyyy/mm/dd)
Incident Sign Off: (Report must se signed off by all listed personnel prior to closure in accordance with the Incident
Classification & Notification Guide)
OS Supervisor:
Print:
Date:
Manager:
Print:
Date:
Safety Coordinator:
Print:
Date:
Incident Review: (Report must be reviewed as per OHS Regulations)
Local OHC Member:
Print:
Date:
For Critical Incidents Only:
Executive:
Print:
Date:
President:
Print:
Date:
Chief Safety Officer:
Print:
Date:
Attachments: (Identify and explain attachments)
Detailed Report
Photos
Diagrams
Other
Description:
Description:
Description:
Explain:
20 of 21
SaskPower
Appendix 4 – IMP Communication Guide
OHSAS 18001 Documentation
Means of Communication
Critical Incident
Minor Incident
Significant Incident
Major Incident
X
X
X
X
X
X
X
X
Data Reporting / Trending
(SafetyNet)
X
X
X
Incident Bulletins
As Necessary
As Necessary
X
X
X
X
X
Verbal Notification
Formal Report
(SafetyNet Incident Reporting)
Postings to Safety Bulletin Boards
(Sanitized Versions)
Local Safety Meetings
Safety Committee Reviews
(Safety Council, Safety Network, Safety
Summit)
Executive Meetings
X
X
X
X
X
X
X
X
NOTE: It is critical that incidents and investigation results be effectively communicated. This flowchart is a guide to communication methods for each
incident type. Additional communication may be required.
21 of 21