The document describes a case study about an employee, Mr. Ockwell, who had an accident at work. It provides context about the accident and outlines the steps the manager took to investigate it. These include sealing off the accident area, taking photos/sketches, reporting it on the ERICA system within 24 hours, establishing the root cause within 48 hours using a Root Cause Analysis form, and interviewing witnesses immediately. The manager used evidence like witness statements and safe operating procedures to determine that the root cause was Mr. Ockwell pulling a pallet truck instead of pushing it as he had been trained.
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2. Welcome to who wants to be a millionaire
Lets PlayQUESTION 1
3. Royal Mails definition of a reportable
accident is 鈥淲hat鈥?
A.
C.
B.
D.
Is one that identifies a specific
injury to a part of the body
whilst engaging in work
activities
Is one that identifies a specific
injury whilst commuting to and from
work
Is one that identified a accident that
nearly happened but caused no injury
Is one that requires first aid treatment
4. Congratulations
YOU JUST WON 拢100
ROYAL MAILS DEFINITION OF AN ACCIDENT IS
ONE THAT IDENTIFIES A SPECIFIC INJURY TO
PART OF THE BOBY WHILST ENGAGING IN
WORK ACTIVITIES
5. Mr Ockwell case study
In 2010, Mr Ockwell was working in his new role in customer compliance and on his first
day, the customer handover became very busy and Mr Ockwell was under increased
pressure and was starting to become very stressed.
As the customer handover started to get less busy, Mr Ockwell took this opportunity to
move pallets around with a pallet truck as he was not MHE trained. There was a little
banter between the experienced customer compliance team and Bob around how busy
the handover became and he was thinking was this the right job for him?
Mr Ockwell continued with his work, and was moving pallets with his pallet truck, when
he came across a pallet that he had missed that was not booked in. He put his pallet
truck into the pallet, and started to walk backwards, pulling the pallet truck and the
pallet towards his work area.
As Mr Ockwell walked backwards, there was a empty pallet on the floor which he was
unaware of, and unfortunately as he walked backwards, he fell over the empty pallet,
landing on his side. Mr Ockwell was in some agony, and the other workers in the area at
the time reported the accident immediately to the line manager.
7. The employee enters the managers office and
approaches the line manager to report the
accident.
What is the priority for the manager at this
moment in time?
A.
C.
B.
D.
Finish the conversation with a
member of staff at Oxford
regarding a non arrival
Address the accident straight away
Note that the accident has
happened and look to investigate
later
Give the employee a camera and
ask them to go take photos
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THE PRIORITY FOR ALL ACCIDENTS AND
INCIDIENTS OVER RIDES ALL OTHER WORK
BEING UNDERTAKEN BY THE SHIFT MANAGER
AND SHOULD BE ADDRESSED STRAIGHT AWAY.
9. Mr Ockwell case study
Once the employee has reported the accident, the manager finishes his conversation
immediately to Oxford and proceeds to the compliance area.
When the manager gets to the compliance area, Mr Ockwell is on the floor and
screaming in some pain. The manager is not first aid trained and there is no first aider on
shift at that time.
The procedure for first aid assistance is to dial 鈥0鈥 on the phone and a first aider would
be sent from another unit on site and this was what the manager had done.
When the first aider arrived, she recommended that a ambulance was called as she
believe Mr Ockwell needed hospital treatment.
The manager called for an ambulance, which arrived within ten minutes and took Mr
Ockwell to the hospital.
11. Mr. Ockwell has now been taken to the
hospital
What should the manager now do with the
scene of the accident?
A.
C.
B.
D.
Tidy up the area and make it
safe for work to continue
Seal of the area
Complete a RCA Complete a HERCA
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YOU SHOULD ALWAYS LOOK TO SEAL OF THE
AREA TO ALLOW FOR YOUR INVESTIGATION. IF
THIS IS NOT POSSIBLE, YOU THEN SHOULD
MAKE THE AREA SAFE TO CONTINUE WORK
13. Mr Ockwell case study
The manager has now sealed of the area, and ensure all the equipment and pallets
remain in the same location to ensure there is no interference to the investigation.
The manager briefly speaks to the staff In the area and they describe to the manager of
what had happened and calls Mr Ockwell's wife to explain what has happened to Bob to
ensure she is informed.
15. Now the area is sealed off,
What should the manager do next as part of
the investigation?
A.
C.
B.
D.
Call the hospital to see if Mr
Ockwell ok
Prepare a return to work for Mr
Ockwell
Take photos/Sketches Report the accident on ERICA
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ONCE THE AREA IS SEALED, MAKE A VISUAL
INSPECTION AND TAKE PHOTOS AND/OR
SKETCHES
17. Mr Ockwell case study
The manager takes photos of the accident area to ensure there is substantial evidence
to help complete the investigation.
Once the photos have been taken, the manager the makes another visual inspection to
make sure everything is captured and nothing is missed.
All photos/sketches must be dated and timed to help form a timeline for the
investigation
If possible, reconstruct the accident, this is especially useful when done with any
witnesses, as everyone see鈥檚 things differently and will enable you to get a fuller picture.
Always record the date and time of the reconstruction!.
19. Once the accident has been raised to the
manager
What is the time scales given to Log the
accident on ERICA?
A.
C.
B.
D.
72 Hours 48 Hours
8 Hours 24 Hours
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Once a accident has been raised to a manager,
the investigating manager has 24 hours to log
this accident onto ERICA
22. Now that the accident has been logged onto
ERICA
How long does the investigating manager
have to investigate the accident?
A.
C.
B.
D.
8 Hours 24 Hours
48 Hours 72 Hours
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Once the accident has been logged onto ERICA,
the manager has 48Hours to establish reasons
for the accident
25. Over the next 48 hours
What is the managers priority in terms of this
investigation?
A.
C.
B.
D.
Attribute Blame
Establish root cause
and countermeasure
Brief StaffEnsure Mr Ockwell
is ok
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Within the next 48 hours,
the investigating managers
priority is to establish root
cause and introduce a
countermeasure
28. What tool can be used to help a manager
establish root cause?
A.
C.
B.
D.
RAC RCA
ACR ARC
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A root cause analysis (RCA) form should be
used to establish who, what, when and why it
happened as well as how it happened.
30. Mr Ockwell case study
When the manager starts completing the RCA, the manager ensures he has the photo鈥檚
that were taken on the day.
The manager would also need to ensure that statements are taken from the witnesses
at the scene. Don鈥檛 be afraid to challenge witness statements, as you are looking to get
to the root cause of what happened.
32. When should the manager look to speak to
witnesses?
A.
C.
B.
D.
Once the investigation is
complete
Immediately before their
views can be changed or
influenced
There is no need to speak
to the witnesses
Whenever, there is no
hurry
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Always look to speak to witnesses immediately
before their view can be changed or influenced.
34. Mr Ockwell case study
Witness statement 鈥 CWU Representative
I was there on the day when Mr Ockwell had his accident.
He was pulling his pallet truck backwards, and I notice there was an empty pallet on the
walkway which should not have been there. As Mr Ockwell walked backwards, he fell
over the pallet landing on his side.
The health and safety in this workplace is poor, and it was only a matter of time before
an accident was going to happen.
Four other witness statements were taken at the time of the accident, and each of the
statements acknowledge that the CWU rep was not at the scene of the accident when
it happened.
36. The manager challenges the CWU statement
In what way can the manager challenge this
witness statement?
A.
C.
B.
D.
Simply discount the
statement from the
investigation
Don鈥檛 challenged, take the
statement at face value
Ask for the witnesses
account of the accident in
reverse
Ask the witness to produce
another statement, and see
if there are discrepancies
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Don鈥檛 be afraid to appropriately
challenge witness statements, you are
establishing cause not blame, ask for
accounts of the accident in reverse to
highlight discrepancies or gaps in
thought process
38. Mr Ockwell case study
The accident is coming to the end of its investigation, in which the witness statements
and photos of the scene has given the manager a clear idea of what has happen.
As part of the managers investigation, he has some assumptions as to what may have
contributed to Mr Ockwell鈥檚 accident at work and the full facts have not been
highlighted through the investigation.
On the day of the accident, Mr Ockwell came into the managers office and said that he
did not realise how busy and stressful the doors would be and maybe he would be
better off processing. The manager said to Mr Ockwell that he needs to gain experience,
and maybe some retraining to build his confidence.
Mr Ockwell agreed, he would give it a week and see how it goes.
40. In the absence of any evidence, what else
can the manager note as part of the
investigation?
A.
C.
B.
D.Rumours Suspicions
Assumptions Opinions
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Make sure you record any and all
assumptions you have to make in the
absence of evidence, these may be
confirmed later or left as assumptions
but must be noted as such and the
reasons behind them explained.
42. Mr Ockwell case study
Now that the RCA is complete, and the investigation is drawing to a close, the manager
reviews the Facts.
The witnesses statements are consistent and acknowledge that Mr Ockwell was pulling a
pallet truck when he tripped over a empty pallet backwards.
The manager reviewed the local safe systems of work which clearly stated that when
using a pallet truck, the operator must push and not pull a load.
Mr Ockwell was briefed this in 2010, 8 weeks before the accident, which included a floor
demonstration. Mr Ockwell signed the WTLL, that he attended the brief.
44. Now the root cause has been established
What should the investigating manager do
next?
A.
C.
B.
D.Update ERICA Brief Staff
Close the case Update the SSOW
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Once the root cause has been
established and countermeasures have
been identified, the second part of the
ERICA can be completed by the
manager, filling in the results of the
investigation and noting actions to be
taken.
47. Unfortunately for Mr. Ockwell, the root
cause for this accident was negligence on his
part because he was working in a way which
was unsafe.
What would the manager do next as part of
the investigation?
A.
C.
B.
D.Complete RCA Inform Mr Ockwell
Complete TWTTP Complete HERCA
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TWTTP focuses on ensuring people have the
correct understanding and provides the data to
make the assessment
Use on an individual basis to determine the
level of operator knowledge
49. Mr Ockwell case study
The investigating manager
performs 鈥渢he way to
teach people鈥 with Mr
Ockwell and the outcome
was that Mr Ockwell
understood all the
workplace instructions and
had the correct
understanding.
51. Mr. Ockwell has acknowledge through the
TWTTP that he understands the work
instructions, what is the next part of the
process?
A.
C.
B.
D.Update ERICA Complete RCA
Update safety board Complete HERCA
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We have demonstrated that lack of knowledge
is not the root cause, and Mr Ockwell is liable
for the injuries is sustained.
54. The HERCA has identified that Mr. Ockwell
has a problem following workplace
instruction
What would be the root cause according to
HERCA?
A.
C.
B.
D.Personal Issues Process Weakness
Attitude and Behaviour Inattentiveness and
forgetfulness
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Once the HERCA is complete and the root
cause identified, the manager must ensure the
countermeasures are fully implemented and
the RCA updated.