Have an idea for a new Confluence Page? Or need to refresh an existing one?

Incident Reporting ( In-progress - DO NOT USE)

Owned by Matthew Daniels
Last updated: May 15, 2024

 

Important Instructions Before You Begin

Please read the following guidance carefully before starting the form. This information is crucial to ensure that the details you provide are comprehensive, clear, and useful for the analysis of the incident and the development of effective preventive measures.

Guidance for Completing Open-Ended Questions:

  • Be Specific: Avoid vague descriptions. Provide specific details about actions, tools, materials, and the environment where the incident occurred. For instance, instead of saying "the equipment was faulty," specify "the conveyor belt halted abruptly due to a torn belt, which was noted to have wear and tear last week."

  • Be Clear: Use simple, direct language to describe the incident. Avoid jargon unless it is commonly understood within your workplace. If technical terms are necessary, consider providing a brief explanation.

  • Be Complete: Cover all aspects of the incident, including what led up to it, the incident itself, and any immediate aftermath. Ensure that no part of the event is left unreported.

  • Provide Context: Explain why certain actions were taken or why specific circumstances prevailed at the time of the incident. This could include details about any decisions made in response to the evolving situation.

  • Include Chronology: Where applicable, detail the timeline of events to illustrate the progression and escalation of the incident. This should include times, and sequences of actions leading up to and following the incident.

Warning: Failing to adhere to these guidelines may result in an incomplete understanding of the incident, potentially hindering effective response and preventive strategies.

Step 1: Access the Incident Report Form

Step 2: Complete the Incident Identification and Participant Information

  1. Identify the Type(s) of Incident:

    • Check the appropriate boxes to specify the type(s) of incident. Available options include:

      • Injury/Illness: Any incident that resulted in physical harm or illness to an individual.

      • Accident/Property Damage: Incidents that involved damage to property or equipment, regardless of human injury.

      • Near Miss: Situations where an incident could have occurred but did not, either by chance or through timely intervention.

      • Environmental Spill: Any release of harmful substances into the environment, including chemical leaks or oil spills.

      • Fire: Incidents involving uncontrolled fire.

    • Select all that apply if the incident involves multiple types.

  2. Information About the Person Filling Out This Form:

    • Enter the name of the KTC employee filling out the form.

    • Add your email address.

  3. Information About the Person(s) Involved in the Incident:

    • Add detailed information for each person involved in the incident. Include all required details without leaving any fields incomplete.

    • You can add multiple entries if more than one person was involved.

  4. Select Your Campus:

    • Choose your campus from the dropdown menu provided.

  5. Add the Campus Director's Email:

    • Enter the Campus Director's email address. This email will be used for sending the approval notification after you submit the report.

  6. Minor or High School Student Involvement:

    • Use the dropdown menu to answer if a Minor or High School Student was involved and whether their Parent/Guardian was contacted.

  7. Submission Preparation:

    • Click "Next" to proceed to the "Details of the Incident" section after completing all fields up to this point.

Step 3: Details of the Incident

  1. Enter the Date and Time of the Incident:

    • Record the specific date and time when the incident occurred.

  2. Provide the Specific Location of the Incident:

    • Describe the exact location where the incident took place, including relevant details like room numbers or area descriptions.

    • Example: Incident occurred in the Culinary Arts kitchen, at the commercial stove area, Station 5.

  3. Describe the Activity Before the Incident:

    • Detail what the employee, student, or visitor was doing immediately before the incident occurred, to provide context.

    • Example: A sudden short circuit caused a small fire near the lab’s main circuit breaker.

  4. List Corrective Actions or Recommendations:

    • Provide a list of actions taken immediately after the incident and recommend measures to prevent future occurrences, addressing the root causes.

    • Example: Installed additional smoke detectors and conducted an emergency response drill for all Graphic Design students.

  5. Personal Protective Equipment (PPE) Usage:

    • Was the student, visitor, or employee wearing proper Personal Protective Equipment (PPE) at the time of the incident? Select Yes, No, or Not Applicable.

    • If Yes: Please explain how the PPE failed and how the incident still occurred.

    • If No: Please explain why the PPE was not worn.

  6. Witness Information:

  7. Submission of Evidence:

    • Do you have any evidence to submit, such as photographs or documents? Select Yes or No.

    • If Yes: Upload the relevant documents.

  8. Submission Preparation:

    • Click "Next" to proceed to the "Type of Incident page" section after completing all fields up to this point.

Step 4: Provide Specific Information Based on Incident Type

  1. Provide Information on the Injured Party:

    • First Name and Last Name: Enter the full name of the individual who was injured or became ill.

    • Relationship to KTC: Specify the relationship of the injured or ill party to KTC (e.g., employee, student, visitor).

    • Location of Injury on the Body: Describe where on the body the injury was sustained.

    • Type of Injury: Describe the nature of the injury sustained (e.g., cut, burn, fracture).

  2. Specify the Type of Injury or Illness:

    • Select the appropriate category that best describes the severity of the injury or illness:

      • Minor: No significant injuries; incidents like minor cuts or abrasions.

      • Moderate: Injuries requiring medical treatment beyond first aid but not life-threatening, such as stitches or minor burns.

      • Serious: Significant injuries needing immediate professional medical attention, like broken limbs or large burns.

      • Severe: Life-threatening conditions requiring emergency response, such as major head injuries or severe chemical burns.

      • Catastrophic: Extremely severe incidents leading to fatalities or massive environmental damage, such as explosions or major structural collapses.

  3. First Aid Administration:

    • Was First Aid Administered? Indicate Yes or No. If yes, provide details on what first aid was given and by whom.

    • Example: The student received first aid for a burn from a soldering iron; the school counselor applied a burn ointment and dressed the wound.

  4. Professional Medical Attention:

    • Did the Individual Receive Professional Medical Attention? Select Yes or No.

    • If "Yes," Provide Additional Details:

      • Name of the Medical Facility: Indicate where the individual was taken.

      • Type of Medical Personnel Consulted: Specify whether the individual was seen by a doctor, nurse, paramedic, etc.

      • Initial Treatments Administered: Describe any immediate treatments given.

    • Example: The student was taken to Central Medical Center where a doctor diagnosed a sprained ankle and applied a brace.

  1. Describe the Damaged Property:

    • Detail the Property: Be specific about the items or structures affected by the damage.

    • Example: Structural damage occurred to a partially completed tiny home when a student mistakenly cut through a support beam.

  2. Explain the Cause of the Accident:

    • Describe what specifically caused the accident, including any contributing factors or conditions.

    • Example: The incident was caused by a student misreading the blueprint and using incorrect measurements, leading to the cutting of a crucial support beam.

  3. Detail Damaged Equipment:

    • Equipment Description: Provide specifics about any equipment that was damaged, including model and serial numbers.

    • Example: The damaged equipment includes a DeWalt circular saw, model DCS391B, serial number DW39103456, which was used by the student during the incident and subsequently dropped, causing alignment issues with the blade.

  1. Select the Type of Near Miss Encountered:

    • Choose from the following categories to accurately classify the near miss. This classification helps in understanding the risks and can guide improvements in safety protocols:

      • Equipment and Machinery: Incidents involving malfunction or misuse of equipment and machinery that could have led to an accident.

      • Procedural Errors: Instances where standard operating procedures are not followed, yet no damage or injury occurs.

      • Environmental Hazards: Situations involving potential environmental risks, such as chemical spills or gas leaks that are contained before causing harm.

      • Physical Hazards: Scenarios including slips, trips, and falls that were narrowly avoided or object falls that didn’t result in injury.

      • Vehicle and Transport: Near misses involving vehicles, whether within the facility or involving external traffic, that could have led to accidents.

      • Electrical Incidents: Potential electrical hazards that were avoided, such as exposure to live wires or electrical faults.

      • Fire Safety Issues: Any fire-related hazards that were identified and addressed before causing a fire.

  2. Identify and Describe the Cause of the Near Miss:

    • Provide a detailed description of what caused the near miss, focusing on the primary risk factors and any immediate circumstances. Be thorough to ensure that the root cause is clearly understood.

    • Example: A near miss occurred when a student forgot to engage the parking brake on a vehicle during a brake inspection, almost causing the car to roll off the lift.

  3. Suggest Actions or Changes to Prevent Future Near Misses:

    • Recommend practical and specific actions that could be implemented to prevent similar near misses in the future. Focus on procedural enhancements or safety measures that directly address the identified risk factors.

    • Example: Implement a mandatory checklist for vehicle setup procedures that must be completed and verified by a peer or instructor before beginning any work, ensuring that all safety measures like engaging parking brakes are adhered to.

  1. Identify the Substance Spilled:

    • Specify the type of substance that was involved in the spill. This information is crucial for understanding the potential hazards and required response.

    • Example: Diesel fuel.

  2. Estimate the Quantity of the Spill:

    • Provide an estimate of how much substance was spilled, using appropriate units of measure to quantify the spill accurately.

    • Example: Approximately 50 gallons.

  3. Determine Hazard Classification:

    • Indicate whether the spilled substance is considered hazardous or non-hazardous. This classification helps determine the necessary safety and cleanup protocols.

  4. List Actions Taken to Contain and Manage the Spill:

    • Detail the immediate actions taken to manage and contain the spill, including any environmental safety measures implemented.

    • Example: Barriers were deployed to contain a chemical spill in the Biomedical Science lab, and the area was ventilated to disperse fumes safely.

  5. Assess the Environmental Impact of the Incident:

    • Choose from the provided options to assess the level of environmental impact:

      • None: No environmental impact was observed or expected as a result of the incident.

      • Minimal: Minor impact that was quickly contained, with no significant long-term effects.

      • Moderate: Caused moderate environmental effects, such as localized contamination that may need remediation but is not expected to be widespread or lasting.

      • Significant: Considerable environmental effects requiring substantial cleanup or remediation, possibly with long-term ecological consequences.

      • Severe: Major environmental impact with extensive damage, requiring significant and prolonged remediation efforts, including large-scale pollution or disruption of ecosystems.

  1. Identify the Source or Cause of the Fire:

    • Specify the origin of the fire, including any details that explain how the fire started. This information is critical for understanding the incident and preventing future occurrences.

    • Example: The fire was sparked by a welding torch that was improperly shut down, igniting sparks that caught flammable debris in the Welding Technology lab.

  2. Describe the Extent of Damage Caused by the Fire:

    • Provide a detailed description of the damage caused by the fire, including both structural and content damage. This helps in assessing the impact and planning the recovery efforts.

    • Example: The fire caused extensive damage to the welding booths and charred several pieces of essential welding equipment, including helmets and gloves. The workshop's ventilation system also sustained significant damage.

  3. Describe the Actions Taken to Contain and Extinguish the Fire:

    • Detail the immediate actions taken to control and put out the fire, mentioning any specific equipment or techniques used. This information is important for evaluating the response effectiveness.

    • Example: Staff used fire blankets and class D fire extinguishers designed for metal fires to quickly extinguish the flames.

  4. Building Evacuation:

    • Indicate whether the building was evacuated as a result of the fire by selecting Yes or No. This helps assess the safety response and the need for potential improvements in evacuation procedures.

  5. Was the Fire Department Contacted?

    • Specify whether the Fire Department was contacted by selecting Yes or No. This information is crucial for assessing the severity of the incident and the appropriateness of the response measures taken.

  6. Was the Fire Intentional?

    • Indicate whether the fire was set intentionally by selecting Yes or No. Understanding the nature of the fire is essential for legal and insurance considerations, as well as for improving security measures.

Proceed to the Statement of Accuracy

  • Click "Next": After you have completed filling in all the details for the specific type of incident, click the "Next" button to proceed to the Statement of Accuracy section.

Step 5: Statement of Accuracy

  1. Read the Declaration:

    • Carefully read the following statement: "I hereby declare that the information provided in this report is true and accurate to the best of my knowledge. I understand that providing false information may result in disciplinary action. Should there be a need to amend any details in this report after submission, please contact Jessica Dill for guidance on the necessary steps."

  2. Sign the Form:

    • Provide your signature in the designated area to affirm that the information you have entered is accurate and complete.

  3. Submit the Form:

    • Click the "Submit" button to finalize your incident report. Ensure that all information is reviewed and correct before submission.

If you have any questions or require further assistance regarding the incident report form, please do not hesitate to contact Jessica Dill at jdill@ktc.edu.