Download - Colorado Rural Electric Association 2009 Loss Control Conference NEAR MISSES REPORT/LEARN/USE
Colorado Rural Electric Association
2009 Loss Control Conference
NEAR MISSES
REPORT/LEARN/USE
Presented By:
Eldon Humphers, CLCP-CUSA
July 14, 2009
NEAR MISSES
A near miss can be an effective tool for
management of safety, health and
environmental programs
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Each cooperative should have in place a
management structure for the application of
a near miss program
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Current Trends in the areas of
Economic Political Regulatory
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Current Trends Have Created The Necessity for
Development of Integrated EHS System
& Focus on Proactive Measures
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Near Misses are one of the best indicators of future problems involving the health and safety of employees.
Detecting Near Misses and Addressing Them Can Improve The Overall Safety Program of A Cooperative.
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Cooperative Safety Programs Are Being Recognized As An Important Reflection of the performance of the Cooperative.
RESAP Currently Using A Cooperative’s Injury Index As A Part of The Accreditation
Process
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Effective Management of EHS Programs
Improve Cooperative’s Operation
Reduce Operating Costs
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Outside influence Non-Governmental
•RESAP•Expectations •Transparency of Cooperative’s
Operation New Demands
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Outside Influence Regulatory Agencies
–OSHA–EPA
•Pro-Active Practices
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PROACTIVE PROTECTION Accident Pyramid Frank E. Byrd, JR Widely Used Widely Accepted
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Accident Investigation Adds New Data One Bad Accident Several Minor/Near Miss Incidents
•Little or No Significant Damage
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Accident Pyramid
Bottom of the Pyramid Information Gained On-Going Basis Identify Potential Exposures
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Address problems when they are identified
Reduce Probability Minimize the Damage
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Effective Management
Identify Weaknesses Reduce Accident Rate Provide Guidance For Improvement
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Proactive Prevention Utilize Minor Incident Information Based on Analytical Approach Systematic Procedure Develop Prognosis Opportunity To Improve Safety
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Near Miss Program
Analysis of Potential Problems Identification of Causes Find Solutions Implement Solutions
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NEAR MISSES ARE THE INCIDENTS AND
OBSERVATIONS AT THE BOTTOM OF THE
PYRAMID.
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Definition Vary From System to System Vary From Person to Person Some Are Narrow Some Are All Inclusive
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Definition
Broader Definitions Increase The Probability
Of Identifying Potential Problems At Their
Earliest Stages
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DEFINITION Example
A Near Miss Is An Opportunity To Improve
Safety, Health, Environmental and
Security of An Operation Based On A
Condition Of An Incident With Potential
For More Serious Consequence.
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Near Misses Always Reflect The Current Status Of A System.
Data Provided by Near Miss Program is Immediately Applicable
Near Miss Management Should Be a Key
Component of EHS Program
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Safety Programs Usually Only Address An Incident After It Happened.
Near Miss Programs Address Incidents and Observations With The Potential For Serious Consequences.
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Consequence
Injury To An Employee Property Damage Damage To The Environment Business Interruption
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LOSS CONTROL INSPECTIONS
•CREA LOSS CONTROL DEPARTMENT•INSURANCE COMPANY LOSS
CONTROL•OSHA•EPA
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INSPECTIONS
IDENTIFY POTENTIAL NEAR MISSES
REPORTS ARE PROVIDED DO YOU TAKE ACTION
OBSERVATION EXAMPLE
SUBSTATIONS
Electrical Tools
Guards should
be in place on
grinders.
Tool rest-1/8”
Tongue guard-1/4”
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THE CONDITIONS REPRESENTED BY THE PREVIOUS SLIDES ARE NEAR MISSES.
IT IS ONLY A MATTER OF TIME UNTIL AN EMPLOYEE SUFFERS AN INJURY.
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Feed Back Initial Cooperative Report Immediately After Investigation Discussions With Management Fine Tune Near Miss Program
Eight Steps of Effective Near Miss Process
•Identification•Disclosure•Priortization•Distribution•Identification of Causes•Solution Identification•Dissemination•Resolution
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IDENTIFICATION
First Step
Recognition
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DISCLOSURE Written Form Reporter Supervisor Procedure Increase Probability
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PRIORTIZATION
Critical Step Depth of Analysis Allocation of Resources Extent of Dissemination
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DISTRIBUTION Those Who Will Analyze Low Priority High Potential Often Occurring Pre-Determined
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IDENTIFICATION OF CAUSES Direct/Root Causes Reporter Committee Priority Determines Extent
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SOLUTION IDENTIFICATION
For Each Cause No Effective Solution Noted Address Each Cause
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DISSEMINATION Communicate Solution Stall The System Manager Permission Inform All Interested Parties Distribution List
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RESOLUTION (TRACKING) Changes
•Execution•Completion•Inform Reporter
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Management System Oversight Team Local Team Near Miss Process Electronic Management Check Effectiveness Training Programs
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Oversight Team Requirements
Define Objectives, Make-Up and Procedures
Guidance In Specific Issues Monitor Performance
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Oversight Team
First Step To Be Implemented
Composition•Managers•EHS Directors/Managers
NEAR MISSES NEAR MISS MANAGEMENT TEAM Responsibilities
•Identify Rules/Responsibilities•Define Details•Design Format•Set Up Criteria•Conflict Resolution•Monitor Performance
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Auditing Quality Control Critical Step Identify and Fix Problems All Levels of Employees
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Training Two Types
•Administrators–Those who will manage the
program
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Administrator Training
Guidelines Tracking Evaluation Improvement
NEAR MISSES Employee Training Subjects
What Are Near Misses Importance of Near Misses Role of Those Involved Near Miss Management System Team Members
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Employee Training Subjects
Near Miss Process Prioritization Help
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Near Miss Management
Powerful Tool Engages Employees Detect Problems
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Full Support Active Involvement Continuous Follow-Up Encourage Reporting Reward Participation Lead By Example
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Seamless Integration
Apply to All Sharing problems Sharing Solutions Enhance Value of Program
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Seamless Integration
Safety Culture Sensitized Employees Reduce Health & Safety Concerns Improve Efficiency
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Single Systems Two Types
•Single–Cumbersome –Detailed–Discourage Employees
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Parallel Systems Confusion Among Employees Which Incident to Report Hybrid System
•Eliminates Problems •Same Procedures
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CONCLUSIONS Best Indicators Resolved Properly Reduce Accidents Improve Quality Improve Productivity
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CONCLUSIONS All Encompassing
•Safety – Health – Environment – Security
•Production & Quality of Work•Timely Indicator•Proactive Program
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Proactive Protection Program Empowers Employees Enables Observation/Resolution Reflects Current Information Identifies Sources of Problems Provides Control of Health & Safety
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A NEAR MISS PROGRAM CAN BE
EXTENDED TO THE PUBLIC SECTOR
BE AWARE
BE SAFE
BE HAPPY
THANKS