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How to get to Lessons Learned as an Industry!
Cherie Whelan
Director Safe Companies
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Current StatusIncident Management Process
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Current StatusHeinrich’s Safety Triangle
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Current StatusA Newfoundlander’s spin on it
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Current StatusReconsidering the Safety Triangle
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Current StatusHow can we identify Serious Injury Fatality potential (SIFp) incidents?
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Current StatusSIFp “Buckets”
NO
NO
NO
NO
NO
NO
NO
NO
NO
Did the event involve...?
1. LOCKOUT
2. Fall from Elevation
3. Mobile Equipment
4. Safeguarding
5. Electrical
6. Hazardous/Bulk Materials
7. Confined Space
8. Hot Work
9. Lifting/Rigging
10. Water Activities
SIF Exposure
NO SIF Exposure
11. Other serious incident or actual Serious Injury/Fatality
NO
NO
YES
1. Had circumstances been slightly different, could the event reasonably resulted in a serious injury or a fatality? If yes, then SIF category.
2. If the situation was repeated a dozen or one hundred times, is it reasonable to conclude the outcome would eventually be an SIF? If yes, then SIF category.
HINT: Think about the incident EVENT; rather than the injury
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Current StatusIs MIR enough?MIR: Calculation: (# of RI’s * 200,000) / Exposure Hours
Is an MIR of 4.0 good and an MIR of 2.0 bad?Bad? it far exceeds the industry standard of 0.0 to 2.0 MIR Good? it fits within the industry standard of 0.0 to 2.0 MIR
What if the 6 RI’s were: 1. Muscle strain, 2 days off work
2. Cut on arm, 2 stitches (non-SIF: worker scratched arm against railing burr)
3. Back strain, 45 days off work (non-SIF: worker picked up one trim-end and strained back)
4. Cracked tooth, Dental work done (non-SIF: worker using rubber mallet struck herself in mouth)
5. Prescription for temporary pain relief
6. Cracked rib (non-SIF: trip/fall same-level, struck ribcage against lunchkit)
What if the 3 RI’s were:
1. Cut on arm, 2 stitches (SIF: Hoist fell when strapping broke, narrowly missing crushing employee to death)
2. Small burn on arm, small infection
3. Cracked tooth, Dental work done (SIF: Fell from height of 28 feet when lanyard pulled out of wall)
And if these events occurred, too (not measured in MIR):
1. Spilled three lumber packages across designated crosswalk (no injuries)
2. 12 serious lockout violations (no injuries)
3. Worker fell 34 feet from roof top onto sawdust pile (FA: iced ankle)
4. Shipping forklift driver slurring, eyes glazed, nodding off in forklift (no injuries)
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Current StatusInvestigation and Causal Analysis
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Current StatusCorrective Actions Follow-up and Lessons Learned
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Current Status
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Current Status
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Current Status
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What can an industry do?
• Identifying SIFp incidents
• Reporting SIFp incidents
• Investigating to Root Cause
• Sharing Lessons Learned….
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WHY CAN’T
IT HAPPENHERE??
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Current StatusSharing Lessons Learned
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Nanaimo Prince George
420 Albert StreetNanaimo, BC V9R 2V7Telephone: 250-741-1060
2666 Queensway StreetPrince George, BC V2L 1N2Telephone: 250-562-3215
Fax: 250-741-1068Toll Free: 1-877-741-1060
www.bcforestsafe.org
Contact Information
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