Accident Investigation Form Miami PDF Details

In the bustling city of Miami, ensuring the safety and well-being of employees within the Parks and Recreation Department stands as a paramount concern. With this commitment to safety in mind, the Accident Investigation Form serves as a critical tool in understanding, documenting, and preventing workplace accidents. This comprehensive form covers a wide array of accident categories, including exposure to hazardous substances, property damage, injuries, illnesses, near-misses, and other non-injury incidents. Required information includes detailed aspects such as the name and classification of the affected employee, the nature of their injury or illness, and a thorough description of the accident scene. The form goes further to probe into the environment of the accident, including weather conditions, machinery, and noise levels, as well as the specific task the employee was performing at the time of the accident. Additionally, it scrutinizes the use of personal protective equipment, adherence to work and safety standards, supervision, and the training the employee received. The meticulous nature of the form ensures that no stone is left unturned in the investigation process, guiding the supervisors or investigators towards identifying and recommending corrective actions to prevent future occurrences. This investigative process not only emphasizes the department’s dedication to safety but also underlines the importance of a structured approach in accident analysis and prevention strategies.

QuestionAnswer
Form Name Accident Investigation Form Miami
Form Length 5 pages
Fillable? Yes
Fillable fields 32
Avg. time to fill out 10 min
Other names Miami accident investigation form, Miami parks and recreation accident investigation

Form Preview Example

City of Miami Parks and Recreation Department Safety Handbook

Appendix/Forms

Accident Investigation Form

ACCIDENT INVESTIGATION FORM

Accident Category:

 

 

 

 

EXPOSURE TO HAZARDOUS SUBSTANCES

 

 

 

PROPERTY DAMAGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INJURY

 

 

 

ILLNESS

 

 

 

NEAR-MISS

 

 

 

NON-INJURY

 

 

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of employee injured, ill or exposed (if applicable):

Classification:

EMPLOYEE WORK EXPERIENCE:

 

 

Full Time

 

 

Part-Time

 

 

How long in current assignment?

How long with the Department?

Seasonal

 

 

Other:

What is the apparent nature of the employee’s injury/illness?

THE ACCIDENT SCENE: Describe the accident scene. Where did the accident happen?

(Example: In the 2nd floor stairwell at 4:20 pm of the Miami Riverside Center Bldg.)

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City of Miami Parks and Recreation Department Safety Handbook

Appendix/Forms

Accident Investigation Form

THE ACCIDENT OR EVENT: Describe what happened. (Example: the maintenance worker removed the cap from the gasoline tank. The gas spilled onto the ground causing the worker to slip and fall. The worker twisted his ankle and broke his arm when he fell).

IDENTIFY WHAT WAS BEING USED: What objects/tools/substances were involved?

(Example: The ladder was not supported; the table saw was in the “on” position; possible lack of oxygen in the confined space; soap and water; cleaning solvent).

DESCRIBE THE WORK ENVIRONMENT? Describe the weather, temperature, light, noise, machinery, aisles, and other features existing at the time of the accident.

WHAT VEHICLE/EQUIPMENT WAS BEING USED (IF ANY)? List the type, brand, name, size, features, condition, age, parts involved, etc. (Include C-No. and Item No. where applicable).

WHAT WAS THE SPECIFIC TASK/WORK ACTIVITY? (Example: Repairing a computer, walking up the stairs, flagging traffic, sitting at a drafting table, walking).

OTHER SPECIFIC ACTIVITY? (Example: posture, movement, using power impact wrench, squatting under conveyor belt, pushing mail cart, lifting copy machine cover, etc.)

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City of Miami Parks and Recreation Department Safety Handbook

Appendix/Forms

Accident Investigation Form

THE WORK CREW: How many in work crew? Working alone or with others?

TIME FACTORS AND THE TIME OF DAY: Describe the time factors related to the shift.

(Example: First half of shift, overtime, rotating, straight eight, rest period, lunch break, entering/leaving the work area).

PERSONAL PROTECTIVE EQUIPMENT/PREVENTIVE MEASURES: Describe protective

equipment being used. (Example: hard hat, glasses, gloves, clothing—did apparel affect the accident?) Were all safety guards in place?

WORK / SAFETY STANDARDS: Did standards exist for the job? Were they written, verbal, followed and understood? Did the employee willfully violate any safety rules?

SCHEDULING OF WORK: Could the work/task have been scheduled at a different time or date?

SUPERVISION: What was the nature of the supervision? Was the supervisor present? Lead worker present?

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City of Miami Parks and Recreation Department Safety Handbook

Appendix/Forms

Accident Investigation Form

TRAINING / INSTRUCTION: Had the employee specifically trained in the activity?

OTHER COMMENTS:

INVESTIGATED BY:

 

DATE:

Supervisor / Investigator

RECOMMENDATIONS:

The following corrective actions are recommended:

1.

2.

3.

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City of Miami Parks and Recreation Department Safety Handbook

Appendix/Forms

Accident Investigation Form

RECOMMENDATIONS APPROVED:

By:Date:

Comments:

COPY SENT TO:

 

Date:

USE THIS SPACE FOR NOTES, SKETCHES AND/OR DRAWINGS:

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How to Edit Accident Investigation Form Miami Online for Free

By following these steps, you can ensure that the Accident Investigation Form is accurately completed. This will give important information on workplace safety and assist in reducing potential future hazards.

1. Determine the Accident Category

Start by identifying the type of accident that occurred. The form provides several categories, such as Exposure to hazardous substances, Property damage, Injury, Illness, Near-miss, Mon-injury, and Others. Based on the incident details, check the appropriate box.

2. Employee Information

If applicable, enter the name of the employee involved in the accident. Provide their classification (full-time, part-time, seasonal, other) and details about their employment duration, both in their current assignment and with the department overall.

3. Nature of the Injury or Illness

Describe the apparent nature of the employee’s injury or illness. Be as specific as possible, providing details about the type of injury or illness and its severity.

4. Describe the Accident Scene

Illustrate where and how the accident happened. Include specific location details and the exact time of the accident. This information should give a clear picture of the scene before the accident.

5. Detail the Accident or Event

Explain the sequence of events that led to the accident. This description should include what the employee was doing at the time, any equipment or substances involved, and how the incident unfolded.

6. Describe the Work Environment

Provide details about the work environment during the accident, including the weather, temperature, lighting, noise level, and any relevant machinery or obstacles.

7. List Vehicles and Equipment Used

If any vehicles or equipment were involved in the accident, list them. Include types, brands, names, sizes, and other pertinent features or conditions.

8. Define the Task and Activities

Specify what the employee was doing at the time of the accident, including their specific task and any other significant actions or movements.

9. Crew and Supervision Details

Note the number of people in the work crew and whether the employee worked alone or with others. Describe the supervision present at the time, including whether a supervisor or lead worker was on site.

10. Protective Equipment and Safety Standards

Indicate any personal protective equipment (PPE) the employee was using and describe any preventive safety measures that were in place, including safety guards. Also, state whether there were any specific work or safety standards applicable to the task and if they were followed and understood.

11. Recommendations and Investigation

After collecting all the above information, the form should be reviewed by a supervisor or investigator who can provide recommendations for corrective actions to prevent future accidents. Finally, document the names of those who investigated the accident, the date, and any other comments or notes.

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