Accident Investigation Program (RMS-1 and RM-15, Rev. 1)CITY OF DELRAY BEACH
ADMIN ISTRATIVE POLICIES AND PROCEDURES
DEPARTMENT : Risk Management POLICY NUMBER: RM-15 and RMS-1
SUBJECT: Accident Investigation SUPERSEDES: p rrv>....,,_l'TI
REVISION: 12/13/2022
APPROVED BY: errence R. Moore, ICMA-CM, City Manager
PURPOSE:
The following Accident Investigation Program, for both industria l (workers' compensation) and vehicle accidents,
has been established to provide a systematic effort to identify all relevant facts and interpretations as to when,
where, how and why an accident occurred so conclusions can be drawn about what must be done to prevent
reoccurrence.
DEFINITIONS:
•Accident, Industrial {Workers' Compensation): An accident or injury that occurs during the course
and scope of an employee's job. •Accident Causes, Direct {Industrial Accident): unsafe conditions (machinery and tools, etc.) in the
workplace or unsafe acts by an employee that directly caused or contributed to the industrial accident.
Examples of direct accident causes are noted on the attached Workers' compensation Accident
Investigation Report (Appendix "A" -for unsafe conditions -item #9 and for unsafe acts -item #10).•Accident Causes, Indirect {Industrial Accident): Workplace conditions or actions taken (or not taken)
by employees or supervisors which created the unsafe conditions or unsafe acts that directly caused or
contributed to the industrial accident. These causes must be identified because they will determine the
corrective actions necessary to prevent recurrence of the industrial accident. Examples of indirect
accident causes are noted on the attached Workers' Compensation Accident Investigation Report
(Appendix "A" -for unsafe conditions -item #11 and for unsafe acts -item #12).•Accident, Vehicle: An accident involving a City vehicle, or an employee-owned vehicle that was being
used on City business, that resulted in bodily injury or property damage.•Accident Causes {Vehicle Accident): The actions of the drivers of the vehicles or any vehicu lar
mechanical defects that cause or directly contribute to an accident. Examples of accident causes (driver
actions) are noted on the attached Vehicle Accident Investigation Report (Appendix "B" -item #18).•Timely Accident Investigation: Conditions at the time of an accident can change quickly and witnesses'
observations can become distorted with time. Therefore, to minimize such roadblocks to accurate and
effective accident investigation, the actual accident investigation must be conducted as soon as practical.
FORMS:
All claims shall be reported to appropriate departmental management and the appropriate forms shall be
completed as referenced herein:
a.Appendix A, Workers' Compensation/Accident Investigation Report", shall be completed by the
Supervisor of employee involved in an automobile accident.
b.Appendix B, "Vehicle Accident Investigation Report", shall be completed by the Supervisor of employee
involved in an automobile accident.
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c.Appendix C,"Vehicle Incident Record,Physical Damage/Unknown Cause",shall be completed for all
City vehicles by a Supervisor as soon as incident involving a City vehicle is reported by an employee.
d.Appendix D,"Physical Damage/Theft of City Property,Non-Vehicular",shall be completed by a
Supervisor for damage to or theft of City property.
e.Appendix E,'Third Party Property Damage,Non-Vehicular",shall be completed by a Supervisor
regarding damage to non-City property.
POLICY:
All Departments within the City will participate in this Program.
PROCEDURE:
EMPLOYEE RESPONSIBILITY
Employees must report all accidents and injuries to their supervisors immediately.Failure to do so may result
in disciplinary action(s)and possible loss of workers'compensation benefits.
SUPERVISOR RESPONSIBILITIES
A.Supervisors must investigate all accidents (industrial or vehicle)that involve their employees or their
employees'assigned City vehicles (or employee-owned vehicles if used on City business)as soon
as possible after the accidents.
B.Supervisors must complete a Workers'Compensation Accident Investigation Report (Appendix "A"),in
the case of an Industrial Accident,and/or a Vehicle Accident Investigation Report (Appendix "B"),in the
case of a Vehicle Accident,in a thorough and timely fashion.All reports must be:completed and
signed/dated by the applicable supervisors within the second full workday following the accident;
reviewed and signed/dated by the applicable Division Heads and Department Heads within the third full
workday;and,received by Risk Manager and the Safety Coordinator within the third full workday.Failure
to provide accurate,complete and timely information may result in the reports being returned to the
applicable supervisors,through their respective Department Heads,for proper completion.
C.Supervisors must complete a Vehicle Incident Record (Appendix "C")when any physical damage to a
City vehicle is observed and the cause for the physical damage cannot be initially determined.
D.Supervisors must complete a Physical Damage/Theft of City Property Incident Record (Appendix "D")
when any physical damage to City property (non-vehicular)is observed or when theft of City property
non-vehicular)occurs.
E.Supervisors must complete a Third-Party Property Damage,Non-Vehicular (Appendix "E")when there is
damage to non-City property (non-vehicular).
INVESTIGATIVE PROCEDURES
As soon as a supervisor becomes aware of an accident involving their employee or involving an assigned City
vehicle or an employee-owned vehicle that was being used on City business at the time of the accident,he/she
is required to implement the following investigative procedures:
A.Initial Actions
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1.In the case of an industrial or vehicle accident,if there are reported injuries to employees,a First
Report of Injury or Illness must be completed,and medical care must be provided in accordance
with the City's Administrative Policies &Procedures Manual (EB-5)-Workers'Compensation
Claims Administration.
2.In the case of a vehicle accident,if preliminary information indicates that there are no injuries or
fatalities and if estimated damages to any City vehicle (or employee-owned vehicle being used
on City business)is less than $500.00 and if the accident occurs on City property and if there is
no damage to the property of others,then there is no need to contact the City's Police Department.
In all other cases,the City's Police Department (or the
Police Department with jurisdiction in the area of the accident)must be contacted to investigate
the accident.
3.After addressing the need for medical treatment and Police response,contact the City's Safety
Coordinator in all cases involving serious injuries (i.e.,Fire Rescue called)or fatalities,in all cases
involving any injuries (actual or possible)to a third party (non-employee)or if assistance is needed
with the accident investigation.
B.Securing the Accident Scene
1.Immediately proceed to the accident scene.
2.The supervisor must ensure that the accident site has been secured as needed to prevent
additional injuries.In the case of an industrial accident,this may mean disconnecting a machine
from its power source,shutting off electrical power,closing a valve or moving equipment and
materials,etc.If assistance is required to effectively secure the site,then appropriate personnel,
to include,if necessary,the City's Fire and/or Police Departments or the Fire and/or Police
Departments with jurisdiction in the area of the accident,must be contacted.In the case of a
vehicle accident (with the exception of a minor accident as noted above),the City's Police
Department or the Police Department with jurisdiction in the area of the accident must be
contacted in all cases to help secure the site and to conduct its own investigation.The
investigating supervisor will support the accident investigation efforts of the Police but not
interfere.
C.Interviewing Employees and Witnesses
The supervisor must interview all injured employees unless this activity will delay medical treatment or if the
employees are extremely upset or in pain.Under these circumstances,the interviews should be postponed but
conducted as soon as appropriate afterwards.Otherwise,supervisors must promptly interview all other involved
employees and other accident witnesses,if any.To make interviews as effective as possible,supervisors should
utilize the following techniques:
Whenever possible,conduct interviews at the accident scene for the following reasons:it is easier to
appraise the degree of accident-related hazards;persons are less likely to deviate from the facts;and,
persons can point out specifics.
If there are multiple employees or other witnesses involved,interview them separately to prevent them
from exchanging views or otherwise influencing each other.
Tell the person being interviewed the primary purpose of the investigation:to determine what unsafe
conditions or unsafe acts caused or contributed to the accident and to recommend appropriate corrective
actions to eliminate those unsafe conditions or unsafe acts thereby helping to prevent a recurrence of
similar type accidents.
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Do not threaten the person interviewed or place responsibility or blame for the accident.Emphasize that
the investigation is fact-finding,not fault-finding.
Whenever possible,maintain note taking to a minimum while interviewing a person.Writing down too
much information during an interview may result in the person being interviewed becoming guarded or
defensive.Do not complete the accident investigation reports until all investigation activities such as
interviews and accident scene assessment,etc.have been completed.
Ask the person being interviewed for his/her complete version of the accident.Do not interrupt the person
or put words in his/her mouth.Only ask questions to fill in the blanks or when the information given is
vague.
Try to avoid asking questions that can be answered simply "Yes"or "No"to aid in obtaining as much
information as possible.
The supervisor should summarize the interview by verifying his/her understanding of the comments and
observations of the person being interviewed.
Ask the employee for his/her ideas regarding what could be done to prevent this type of accident from
recurring.
D.Examining the Accident Scene
1.In the case of an industrial accident,examine the accident scene based on the information
gathered during interviews.Record any conditions associated with the work area,machinery,
tools,materials,structures or equipment,etc.that may have contributed to the accident and
identify any property that was damaged,describing the damage.If needed to effectively
communicate the accident scenario,pictures of the accident scene,etc.should be taken and/or
a diagram should be prepared noting the types and locations of machinery,materials,tools and
other relevant objects along with the locations of all involved employees and other accident
witnesses at the time of the accident.
2.In the case of a vehicle accident,examine the accident scene based on the information gathered
during interviews.Note the directions of travel and the positions of all involved vehicles at the
time of the accident,the locations and types of traffic controls and signs (if applicable),the
locations and identities of any objects that were damaged as a result of the accident,and any
other conditions (weather,lighting and road conditions,etc.)that may have contributed to the
accident.If the Police Department investigates the accident,the police report should be used as
a source for this information.
3.In conjunction with the vehicle accident scene examination,all vehicles involved in the accident
should be assessed for damages along with any property that was damaged.If the Police
Department investigates the accident,the police report should be used as a source for this
information.
E.Accident Evaluation and Reporting
1.Supervisors must evaluate all information obtained from the accident investigation (interviews,
accident scene examination and damage assessments,etc.)in order to establish an accurate
description of the accident,all accident causes and appropriate corrective actions.Supervisors
must consider the following when conducting evaluations:
As an accident investigator,the supervisor is not merely a collector or reporter of data,but
rather an evaluator of statements,claims,facts and opinions,etc.
When describing an accident,clearly differentiate between an occupation and a job.
Examples of occupations include electricians,welders,plumbers,police officers and
paramedics,etc.Jobs are limited to focused activities (examples include repairing a machine,
pouring concrete,installing a barrier or changing a light bulb,etc.).
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Most industrial accidents have multiple direct and indirect causes,which usually consist of a
combination of one or more unsafe conditions and one or more unsafe acts.Many vehicle
accidents also have multiple causes (driver actions and/or vehicular mechanical defects).All
causes should be determined.
To conclude the evaluation,appropriate corrective actions must be developed for fill of the
accident causes.This activity is one of the most important parts of an accident investigation.
Examples of appropriate corrective actions for industrial accidents are noted under Item #13
of the Workers'Compensation Accident Investigation Report (Appendix "A").Examples of
appropriate corrective actions for vehicle accidents are noted under Item #21 of the Vehicle
Accident Investigation Report (Appendix "B").
In the case of a vehicle accident,possible corrective actions include drug and alcohol testing.
Administrative Policies &Procedures PER-12 (Comprehensive Drug and Alcohol Abuse
Policy)and Administrative Policies &Procedures PER-9 (Alcohol and Drug Testing Program
for Commercial Motor Vehicle Drivers)provide instructions on when testing should be
conducted.
2.The final step of the accident investigation is the completion of the appropriate accident
investigation report (refer to SUPERVISOR RESPONSIBILITIES above).The report should be
completed as instructed and in a thorough and timely fashion.Be sure to note who is responsible
for corrective actions and an approximate time frame for compliance.Also,supervisors must
attach to the accident report all supplemental information (diagrams,photos and police report,
etc.)in order to effectively communicate their investigation findings.
3.If a vehicle accident results in injury to a third party (non-employee),either actual (i.e.,ambulance
response)or possible injury,the supervisor must investigate the accident and complete the
Accident Investigation Report in consultation with the City's Safety Coordinator.
F.Corrective Actions
1.After the accident investigation has been completed and the accident reports submitted to the
appropriate persons,supervisors must notify all persons responsible for corrective actions
regarding the details of the corrective actions and the need for prompt attention.Also,supervisors
must follow-up with these persons 48 hours to ensure that the corrective actions have been
properly implemented.
2.Finally,supervisors must review the results of their investigation,noting their determinations as
to the accident description,accident causes and corrective actions with those employees who
were involved in the accident and other employees who conduct similar operations.
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Appendix "A"
City of Delray Beach
Workers'Compensation
ACCIDENT INVESTIGATION REPORT
Note:Supervisor must fill out this report completely and in a timely fashion.Failure to provide accurate and complete information
may result in this report being returned to the applicable Supervisor (through his/her Department Head)for proper completion.
This report must be completed and signed/dated by the applicable Supervisor within the second full workday following the
accident;reviewed and signed/dated by the applicable Division Head and Department Head within the third full workday;and,
received by the Risk Manager and the Safety Specialist within the third full workday.
1.Employee's Name:2.Job Title:3.Dept./Div.Code:
4.Accident Date:5.Time:6.Date accident reported to supervisor:
7.Accident Location:
8.How did the accident happen?Describe:the specific job being done by the employee;and,what occurred to trigger the
accident.Use the reverse side of this report for additional comments,if needed.
9.What unsafe condition(s)of machinery,tools,10.What unsafe act(s)by the employee directly caused
equipment or the work area directly caused or or contributed to the accident?
contributed to the accident?Check all that apply:Check all that apply:
1.None ()1.None
2.Defective machinery,tools or equipment ()2.Failed to follow safety procedures/rules
3.Inadequate machine or power tool guarding ()3.Failed to make equipment/material secure
4.Inadequate safety devices ()4.Failed to warn or signal
5.Fire or explosion hazards ()5.Failed to follow supervisor's instructions
6.Unguarded floor openings ()6.Did not use proper personal safety equipment
7.Unprotected excavations ()7.Used improper or defective tools/equipment
8.Improper housekeeping ()8.Used tools or equipment improperly
9.Tripping/slipping/protruding hazards ()9.Took unsafe position
10.Inadequate illumination or ventilation ()10.Used improper lifting techniques
11.High noise levels ()11.Operated at unsafe speed
12.Causes other than above ()12.Causes other than above
Describe:Describe:
11.What directly caused or contributed to the above noted 12.What directly caused or contributed to the above noted
unsafe condition(s)?Check all that apply.unsafe act(s)?Check all that apply.
1.Defective via normal use ()1.Unaware of hazards
2.Defective via abuse/misuse ()2.Unaware of safety procedures/rules
3.Faulty design ()3.Low level job skill
4.Faulty construction ()4.Ignored known hazards
5.Preventive maintenance failure ()5.Tried to save time
6.Safety inspection failure ()6.Tried to avoid effort
7.Caused by employee ()7.Tried to avoid discomfort
8.Caused by other employee(s)()8.Illness/fatigue influenced action
9.Housekeeping procedure deficiency ()9.Suspected drug/alcohol use
10.Improper job planning.()10.Defective hearing/vision
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13.What corrective actions have been taken (x)or will be taken (o)to prevent recurrence?Mark all that apply:
1.Reinstruct employee(s)involved
2.Discipline employee(s)involved
3.Preventive reinstruction of other employee(s)
4.Job reassignment of employee(s)
5.Improve inspection procedure
6.Improve housekeeping procedure
7.Improve preventive maintenance procedure
8.Improve illumination
9.Improve ventilation
10.Install safety guards/devices
11.Provide personal protective equipment
12.Repair/replace tools and/or equipment
13.Use safer materials
14.Perform job safety analysis
15.Establish safety procedures/rules
16.Correction other than above
Describe:
14.Describe details of corrective action(s)taken or planned.
15.Who is responsible for corrective action(s)?
16.When will corrective action(s)to be implemented?
17.Names of witnesses,if any?If witnesses are other than City employees,addresses and phone numbers are required.
18.Additional comments:
19.Type of medical care provided:
First Aid ;Doctor ;Hospital.Will employee miss time from work?
Investigated by (Supervisor's signature/date):_
Reviewed by (Division Head's signature/date}:_
Reviewed by (Department Head's signature/date}:_
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Appendix "B"
City of Delray Beach
Vehicle
ACCIDENT INVESTIGATION REPORT
This report is prepared in anticipation of litigation)
Note:Supervisor must fill out this report completely and in a timely fashion.Failure to provide accurate and complete information may
result in this report being returned to the applicable Supervisor (through his/her Department Head)for proper completion.This report
must be completed and signed/dated by the applicable Supervisor within the second full workday following the accident;reviewed and
signed/dated by the applicable Division Head and Department Head within the third full workday;and,received by the Risk Manager
and the Safety Coordinator within the third full workday.
CITY VEHICLE INFORMATION
1.Employee:2.Dept./Div./Code:3.Vehicle#:
4.Vehicle Year/Make/Type/Color/Damages:5.Vehicle Plate#:6.Accident Date:
7.Time:8.Police Report #,if applicable:
9.If required by the City's Accident Investigation Policy,were Police contacted?If not,why not?
10.Accident Location:
11.Names of passengers in City vehicle (or employee-owned vehicle being used on City business),if applicable.If passengers are
other than City employees,addresses and phone numbers are required.
OTHER VEHICLE INFORMATION
12.Owners Name,Address,Phone#:
13.Vehicle:Year/Make/Model/Color/2-4 doors/License Plate#:
14.Driver's Name,Address,Phone#(if different from the owner,relationship):
15.If possible,Name,Addresses,Phone Numbers,Ages and Gender of all passengers:
16.Names of injured persons (including pedestrians),if applicable.If injured persons are other than City employees,addresses and
phone numbers are required:
17.If City employees were injured,have "First Report of Injury"been sent to Risk Management?If not,why not?
18.Were vehicles occupants wearing seat belts?If not,why not?
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19.Names of witnesses,if any.If witnesses are other than City employees,addresses and phone numbers are required.
20.Did Supervisor conduct investigation at accident scene?If not,why not?
21.Based,as applicable,on information supplied in the police report and by drivers,passengers and witnesses,an assessment of
the accident scene and an inspection of damaged vehicles,etc.,Describe in detail how the accident occurred,use a separate
sheet and attach to this report if needed,a diagram is also helpful.
22.What did the driver (employee)do or fail to do that caused or contributed to the accident?Be specific:too fast for conditions;
not watching road;following too closely,passing,cutting or crowding;not adhering to traffic signs and signals;improper
backing;and/or improper turning,etc.
23.Did any of the drivers receive a traffic citation?Why?
24.Any vehicular mechanical defect that caused or contributed to the accident,as determined by the City's Central Garage and/or
an Authorized Dealer?
25.What corrective actions have been taken (x)or will be taken (o)to prevent recurrence?Mark all that apply.
l1.Vehicular mechanical defect repair/elimination
D 2.Reinstruct driver regarding safe driving techniques
3 .Driver attendance at defensive driving school
4 .Drug/alcohol test if required by Administrative Policies &Procedures (PER-12)or union contracts
Os.Drug/alcohol test for COL drivers if required by Administrative Policies &Procedures (PER-9)
D6.Other actions (Describe):
D7.No corrective actions necessary
26.Who is responsible for corrective action(s)?
27.When will corrective action(s)to be implemented?
Investigated by (Supervisor's signature/date}:_
Reviewed by (Division Head's signature/date):_
Reviewed by (Department Head's signature/date}:_
Distribution:
Original:Risk Management
CC:Employee File
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Appendix "C"
CITY OF DELRAY BEACH
Vehicle
Incident Record
Physical Damage -Unknown Cause)
Vehicle Description/Number:Department:
Date of Incident:Time Incident Reported:
AM or PM
Description of physical damage (cosmetic and/or mechanical):
Name of employee who observed damage:
Was damage observed via a "walk-around inspection"of the vehicle by the driver?
Yes No
If No,how as damage observed and by whom?
Name of employee who last operated the vehicle:
Supervisor's Signature:_Date:_
Original:
cc:
Central Garage
Department and/or Division Head
Supervisor
Risk Management
Safety Coordinator
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Appendix "D"
CITY OF DELRA V BEACH
Physical Damage/Theft of City Property
Incident Record
Non-Vehicular)
Property description:
Property in possession of:
Date of Incident:Time of Incident:
AM or PM
Department:Division:
Description of physical damage and/or theft:
Explain how physical damage and/or theft occurred:
Correction actions to prevent recurrence:
Supervisor's Signature:_Date:_
Original:
cc:
Department and/or Division Head
Risk Management
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Appendix "E"
CITY OF DELRAY BEACH
Third Party Property Damage
Incident Record
Non-Vehicular)
Property owner and address:
Property description and/or location:
D ate of Incident:
D e p art me n t:
Time of Incident:
Division:
AM or PM
D es cription of damage to propert v
Explain how property damage occu rred:
I
Co rrect iv e actio ns to prevent recurrence:
Supervisor's Signature.[a[e;
O rig ina l.
cc.
De partm e nt and/or Div isio n Head
Risk Ma nage m ent