Accident Report
INCIDENT REPORT INSTRUCTIONS
Northwestern University Vice President for Research University Safety Committees Office for Research Safety
***A sample completed form is appended to these instructions.*** When to Submit an Incident report
An incident report must be delivered to the Office for Research Safety within five days of the incident. Reports are reviewed by the Chemical and Biological Safety Committee, or the Radiation Safety Committee. An incident is defined as any unplanned and unwanted event that occurred during the performance of work activities and that resulted in or could have led to injury or material damage to property. Incident repercussions range from minor (e.g., a broken mercury thermometer) to significant (e.g., a 5-gallon bottle of sulfuric acid dropped in a heavy-traffic hallway). An Incident Report is appropriate for “near misses,” incidents not resulting in personal harm or property damage, but which might have, under slightly different circumstances. The Incident Report requires responses from (I) the person involved, (II) any witnesses to the incident, and (III) the Principal Investigator/Supervisor. Attach additional pages if necessary to complete the report. Reports that are not signed by the PI/supervisor will be returned for completion. The committees require input from the supervisor. See completed Example following the instructions. Commonly, there are multiple causes in any given incident—all of which should be identified. Provide a complete and detailed response to each question, making a serious attempt to identify all “root cause(s).” The contributing factors were probably evident, but overlooked or unrecognized previously. These factors become more distinctly identifiable in light of the specifics of the incident A well-planned work process will include multiple layers of safeguards. Once causes are identified at all levels, consider safeguards and procedures that might be changed to prevent future incidents. .
Northwestern University Vice President for Research University Safety Committees Office for Research Safety
***A sample completed form is appended to these instructions.*** When to Submit an Incident report
An incident report must be delivered to the Office for Research Safety within five days of the incident. Reports are reviewed by the Chemical and Biological Safety Committee, or the Radiation Safety Committee. An incident is defined as any unplanned and unwanted event that occurred during the performance of work activities and that resulted in or could have led to injury or material damage to property. Incident repercussions range from minor (e.g., a broken mercury thermometer) to significant (e.g., a 5-gallon bottle of sulfuric acid dropped in a heavy-traffic hallway). An Incident Report is appropriate for “near misses,” incidents not resulting in personal harm or property damage, but which might have, under slightly different circumstances. The Incident Report requires responses from (I) the person involved, (II) any witnesses to the incident, and (III) the Principal Investigator/Supervisor. Attach additional pages if necessary to complete the report. Reports that are not signed by the PI/supervisor will be returned for completion. The committees require input from the supervisor. See completed Example following the instructions. Commonly, there are multiple causes in any given incident—all of which should be identified. Provide a complete and detailed response to each question, making a serious attempt to identify all “root cause(s).” The contributing factors were probably evident, but overlooked or unrecognized previously. These factors become more distinctly identifiable in light of the specifics of the incident A well-planned work process will include multiple layers of safeguards. Once causes are identified at all levels, consider safeguards and procedures that might be changed to prevent future incidents. .