DRS Injury Near Miss

• Conducted on

  Date

• Prepared by

• Location
  Address

IDENTIFY THE PROBLEM

• What happened? When did it happen? What circumstances were involved? Where did it happen? Why did the tech do what he did?

• What is the specific injury or symptoms? What body part was affected?

• Describe how serious the injury is or could have been. How long will/would it take the tech to recover?

DEFINE POSSIBLE CAUSAL FACTORS

• What sequence of events lead to the problem? (was a safe work procedure used? Had conditions changed to make the normal procedure unsafe? Were the appropriate tools and materials available? Were they used? Were safety devices working properly?

• What conditions allow the problem to occur? (was there an equipment failure? what caused it to fail? Should PPE have been used? Was the PPE used? Was the tech properly trained to use the PPE?)

• What were the problems surrounding the occurrence of the central problem? (What were the weather conditions? Was poor housekeeping a problem? Was it too hot or too cold? Was there adequate light? Were safety rules communicated to and understood by the employee? Were they being enforced? Were workers trained to do the work? Had this hazard been previously identified? Was regular maintenance of the equipment carried out? Were regular safety inspections carried out?)

RECOMMEND A SOLUTION

• What did the tech learn from this incident?

• What is the real reason the problem occurred? What was the Root Cause?

• What is the solution? How will the solution be implemented? Who will do it? When will it be completed?