(1) Incident investigation is an important process to determine the events and factors that led to a hazard, injury, illness, incident or other system failure. (2) Through the process of conducting incident investigations, an understanding develops of the relationship among the events, and in doing so, provides clarity for organisational action in the effort to prevent reoccurrence. (3) The purpose of this Procedure is to provide a clear framework on how health and safety incidents are investigated so that necessary corrective actions and the lessons learnt are identified and implemented across the organisation in the effort to prevent reoccurrence. (4) Refer to the Health and Safety Policy. (5) Refer to the Health and Safety Policy. (6) Provide the necessary resources to conduct incident investigations. (7) Provide oversight and monitor this procedure. (8) Participate in incident investigations as required. (9) All Health and Safety incidents will be investigated. (10) The level of investigation will be determined by the incident rating as described using the University risk matrix and utilising the following: (11) Incident investigation will be initiated as soon as possible after the incident is reported through either: (12) Incidents fall into the current categories: (13) All incident investigation will follow the PEEPO contributing factors model in which causation is categorised as follows to identify where the failure/s has occurred. (14) PEEPO contributing factors: (15) This methodology will identify a breadth of corrective actions to ensure that the underlying causes are comprehensively understood and addressed. (16) The HSE Team will initiate basic incident investigation in conjunction with the relevant Manager / Leader. The incident investigation template will be utilised to capture and address: (17) The HSE team will lead a full incident investigation and, with the organisational leadership will establish an investigation team. Members of investigation teams will vary but may include: (18) The Investigation Team will collect evidence relevant to the incident. This may include: (19) The Investigation Team will conduct interviews with both direct and indirect witnesses. (20) Following the investigation, the lead investigator will use the incident investigation template to prepare an analysis of the incident and identify the corrective actions necessary to prevent reoccurrence. (21) Corrective actions will be implemented by Leaders / Managers that is within their organisational authorities to do so. (22) Implementation of the corrective actions will be monitored by the HSE team to ensure their completion. (23) The HSE team will periodically review the corrective actions that are operational to ensure these are effective and/or identify where deficiencies exist for additional correction. (24) The wider lessons learnt though the corrective actions, broader trends and deeper insights will be communicated across the university community. This may include: (25) All documentation relevant to an investigation will be electronically captured and kept in a retrievable file for a period of 10 years. (26) Managers and leaders will be identified across the Schools and Divisions to complete incident investigation education and training. (27) For the purpose of this Procedure:Health and Safety Procedure - Incident Investigation
Section 1 - Background and Purpose
Section 2 - Scope
Section 3 - Policy Statement
Section 4 - Procedures
Part A - Responsibilities
Managers and Leaders
Health, Safety and Environment (HSE) Team
All Staff, Students and Contractors
Part B - Incidents Requiring Investigation
Part C - Incident Investigation Methodology
Part D - Basic Incident Investigation
Part E - Full Incident Investigation
Part F - Corrective Actions
Part G - Lessons Learnt
Part H - Documentation
Part I - Education & Training
Section 5 - Definitions
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