Accident Report

INCIDENT REPORT instructions Northwestern University ? Vice chair for search ? University asylum Committees ? Office for look resort ***A sample fattend form is appended to these instructions. *** When to Submit an chance report An incident report must be delivered to the Office for Research sanctuary within five days of the incident. Reports argon reviewed by the chemic and Biological Safety Committee, or the Radiation Safety Committee. ? An incident is outlined as any unplanned and unwanted event that occurred during the performance of stimulate activities and that resulted in or could have led to injury or substantive damage to property. accompanying repercussions range from minor (e. g. , a broken mercury thermometer) to meaningful (e. g. , a 5-g wholeon bottle of sulfuric caustic dropped in a heavy-traffic hallway). ? An contingency Report is appropriate for near misses, incidents non resulting in personal reproach or property damage, still which might have, n ether slightly antithetical circumstances. ? The nonessential Report studys responses from (I) the person involved, (II) any witnesses to the incident, and (III) the superstar Investigator/Supervisor. wed additional pages if necessity to complete the report.Reports that are non signed by the PI/supervisor give be returned for completion. The committees require input from the supervisor. follow up completed Example following the instructions. ? Commonly, in that location are multiple causes in any given incidentall of which should be identified. Provide a complete and detailed response to each question, making a knockout attempt to identify all root cause(s). The contributing factors were probably evident, but overlooked or unrecognized previously. These factors become more distinctly acknowledgeable in light of the specifics of the incident A well-planned work process go out include multiple layers of safeguards.Once causes are identified at all levels, disregardvas s to it safeguards and functions that might be changed to prevent future day incidents. . ? This report is not mean to assign blame it should be use as a woodpecker to foster recommendations for procedural improvement. A well-prepared report will identify all work systems that need to be redesigned to compensate for foreseeable human errors. info gleaned from these reports will also be used to improve safety policies. ? The Incident Report is required for all incidents, and must be submitted to theOffice for Research Safety within 5 business days of the incident. Delaying may result results in lost or forgotten details. Your department will be contacted by the Office for Research Safety if an incident report is not real promptly. Incident Response ? Please refer to the Emergency Response nurture Fact Sheet Section 6. 3. 4 of Chemical and Biological Safety in Laboratories for definitions of incidental buttons you can clean up yourself versus major spills that require assistan ce, either by ORS or an outside agency. When in doubt, contact ORS for help.Both types of spill require an incident report. ? Emergency Phone Numbers and procedures may be found in your department emergency evacuation plan, your Safety Desk Book, your Employee Safety Handbook, or the Office for Research Safety web page http//www. investigate. northwestern. edu/enquiry/ors/emerg/index. htm The Incident Report Form is located at http//www. research. northwestern. edu/research/ORS/online_forms. htm under Laboratory Safety Forms. Incident Report Instructions and model Updated 4/18/2007 INCIDENT REPORT SAMPLE Northwestern University ? Vice President for Research ?University Safety Committees ? Office for Research Safety ***Instructions on when and how to complete this form may be found at http//www. research. northwestern. edu/research/ORS/online_forms. htm under Laboratory Safety Forms. *** Hint Save this file to your computer, complete your section, email a copy to the adjacent pers on for their part, and when all culture has been entered, printed, and signed by the of import Investigator, return it to Tech, NG-71 . I. Report by person involved Name __Josephine Doe____________ Department ___Chemistry_________DatePrepared December 20, 2007__ How long at this labor? _3 wks______Position/Title (e. g. , Grad Student, Technician, Post-doc) ___Graduate Student___ Location of Incident ___Tech G222_________Date/ term of incident _December 18, 2007_ / Principal Investigator/Supervisor ___Frank Nobel_________________________ 730 am_____ A. reveal how the incident occurred. 1. con make the operation in which you were involved. What were you doing before the incident occurred? What was your goal? What were you doing at the time the incident occurred? What were the conditions of your work?Is this a routine operation? I was serve a volumetric flaskful. I added a mixture of acid (hydrochloric and nitric) to the flask, a procedure typical in our lab. I was attribute th e flask and swirling the acid along the inner walls. 2. Describe the incident in detail. What happened? A reception occurred inside the flask. I had pollped it to prevent spillage. A pressure build-up blew the cap off the flask and sprayed acid on my face. In shock, I dropped the flask on the bench and it shattered, spilling acid on the surface. 3. Describe the sequence of events that followed the incident.How did you suffice? I ran to the eyewash at the sink and rinsed my face for approx. 15 minutes, holding my eyes open with my hands. I called UP and requested emergency assistance. Paramedics arrived more or less 10 minutes after that. 4. Describe any equipment, machinery, or instruments in use at the time of the incident and their potential contribution to the incident. No equipment involved. B. Did you sustain any injuries? What were they? How were they treated? Did you require medical care? Describe the severity of the injury. foliate 2 of 5 PagesLimited burns to my face o n my forehead and eyelids. I was taken to the emergency room where my face was rinsed once again and treated with topical antibiotic cream. I will have to lift sunlight for a week since I sustained a second-degree burn. C. Was there any property loss or damage? Please elaborate. The flask was broken. The acid permanently stained the work surface. Acid was sprayed as further as 20 feet from the spill site. ORS cleaned the acid contamination. The lab was closed the next morning after the spill because no one could work in the area while ORS decontaminated it.D. Safety Rules and Procedures. 1. Was the use of personal protective equipment (PPE) necessary during the given operation? Was the PPE worn? What did it consist of? I was takeing a lab coat and nitrile gloves but no eye protection. I should have been wearing safety glasses. 2. What type of training did you receive forward to engaging in this operation? Was the training adequate? What did it consist of? I received ORS general safety training when I entered the program my first-year year. No training since then. Also, no training in my lab as to specific procedures.I believe I should have annual refresher training. 3. argon there any specific safety rules which apply to this procedure? Were they followed? be they adequate? No specific rules established for cleanup spot of glassware. There are rules regarding PPE. Safety glasses are required and I will wear them from now on. 4. separate comments. I was functional alone in the lab. I wont do that again since I could have used help in locating the eyewash. E. Causal Factors 1. What do you recognize to be the causal factors behind this incident?This could include inadequate watchfulness circumspection lack of appropriate safety policy proper equipment not used, required, or supplied etc. Lack of a standardized procedure. An adverse answer amid the acid and contaminants was never addressed in training so I didnt realize it could occur and how to ade quately handle the situation. 2. What are your recommendations for preventing replication? Better awareness (training) roughly the reactions that can occur between chemicals. II. Other Individuals Involved/Witnesses where applicable 1. Name __None____________________ Position_____________________ _A. Description of Incident Where were you and what were you doing when the incident occurred? What did you see? Page 3 of 5 Pages Incident Report Instructions and Sample Updated 4/18/2007 B. Additional comments or observations. 2. Name __________________________ Position_____________________ _ A. Description of Incident Where were you and what were you doing when the incident occurred? What did you see? B. Additional comments or observations. III. Report by Principal Investigator/Supervisor A. How and when did you learn of the incident? I received a phone call from the student the next day.B. Contributing/Mitigating Factors What do you perceive to be the causal factors behind this inc ident? This could include inadequate management oversight lack of appropriate safety policy improper procedure proper equipment not used, required, or supplied etc. There was a reaction between the acid and an organic contaminant in the glassware. The flask should not have een capped. The capping caused a pressure build-up to occur in the vessel. The student did not consider the possibility since we had not discussed glassware cleaning procedures. C. Immediate tonic action taken.The use of acids for cleaning glassware will be about evaluated to determine when a less hazardous cleaning agent can be used. To limit the potential for reaction, we will ensure that any gross organic contamination is removed by thorough rinsing and scribble before use of acid. Acid will be restricted to cleaning of trace contamination. When lab personnel clean with acids, regular venting will be performed to prevent pressure build-up. Also, the procedure will be done in a chemical fume hood, utilizing t he horizontal sash as a physical barrier against sprays and splashes.D. Additional remediation efforts to prevent future recurrence (and expected date of implementation). We will schedule an in-house training come apart to review the cleaning procedures and other lab safety policies, especially the rules about wearing of PPE and working alone. Page 4 of 5 Pages E. Comments The student was working an 11-hour day. Fatigue may have been a factor. Workdays will be hold to 10 hours at the most. Principal Investigator/Supervisor Signature ____________________________________ Page 5 of 5 Pages