Your company has a strong safety culture with outstanding employee participation. Everyone is committed to safety and goes out of their way to do things in the safest way possible. As a safety professional, everything is great in your world until suddenly, a “near-miss” report lands on your desk. Supervisors, managers, and company executives are now concerned, worried, or even stressed out about the fact that something unsafe just happened at their company! Many would-be quick to speculate that a near miss is a bad thing; however, as a safety professional, you know that this is not necessarily the case. The reality is, a near-miss or “good catch” report can be one of the most valuable tools for improving your company’s safety program.

What is a Near Miss?

According to OSHA, a Near Miss is an unplanned event that did not result in an injury, illness, or damage – but under different circumstances, could have. Your company may have another term for a near miss such as “close call,” “good catch,” “narrow escape,” “near hit,” “cliffhangers,” or a number of other terms. However, at the end of the day, these are all near misses. Near misses are caused by the same things as accidents: unsafe conditions and/or unsafe behaviors. Near misses are often precursors to accidents and should not be ignored. In fact, according to the National Safety Council (NSC), 75% of all accidents are preceded by one or more near misses.

Heinrich’s Law and Bird’s Safety Triangle

In 1931, Herbert Heinrich published Industrial Accident Prevention: A Scientific Approach where he proposed a concept that would eventually become known as “Heinrich’s Law.” Heinrich’s law states that for every accident that causes a major injury, there are 29 accidents that cause minor injuries and 300 accidents that cause no injury (i.e., near misses).

Years later, Frank Bird analyzed nearly 2 million incident reports from over 300 companies and used his findings to amend and expand upon Heinrich’s theory. Bird developed the “Safety Triangle” (depicted here) which states that for every fatality, there will be 10 serious accidents, 30 minor accidents, 600 near misses, and an unknown, but significant number of unsafe acts. The important thing to take away from this is that near-miss reports should be taken seriously, investigated, and used to prevent future incidents.

Near Miss Reported – Now What?

A Near Miss report is submitted. You’re thankful that it wasn’t an injury report, but you also realize that this could have easily been one under different circumstances. You also realize that this is a potential precursor to something worse, so now what? The answer – Root Cause Analysis. There are many different models to choose from when conducting RCAs. The “5-why” is one of the most popular choices due to its simplicity; it is also recommended in ANSI Z-10 Standard for Occupational Safety and Health Management Systems. There are other formats that are equally effective such as the fishbone diagram, also known as the Ishikawa diagram, Failure Mode and Effects Analysis (FMEA), scatter plots, and many others. What format or method you choose is not as important as actually performing RCAs in the first place. The key takeaway here is, use whatever format you are most comfortable with, as long as you ensure that RCAs are performed when necessary.

There’s almost always a deeper root cause to why a near-miss occurred. While there may be an obvious reason on the surface level, by digging a little deeper into the situation, you may find that there’s more than meets the eye. Correcting the immediate cause may help to resolve the symptom of the problem, but not the problem itself.

For example, a worker at your facility slips in a puddle of water on the floor and falls. The worker is not injured and as a result, a near-miss report was submitted. The investigation should not conclude with “employee slipped in puddle and fell – instructed employee to be more aware of their surroundings.” An effective root cause analysis would instead look for deeper issues, such as:

• Why was the puddle there in the first place?
• Where there changes in the environment, weather, conditions, or a process?
• What was the source of the water?
• What tasks were being performed when the water was spilled?
• Why was the water not cleaned up?
• How long was the water there?
• Was the spill reported?

By performing a root cause analysis, you may learn that it was raining on the day of the near-miss and that the roof in your warehouse has developed a leak, causing a puddle of water to form, creating the unsafe condition that led to the incident. Simply instructing the employee to be more aware of the surroundings may prevent them from slipping again; however, it will not prevent the unsafe condition from reoccurring. The true root cause needs to be addressed; the roof must be repaired.

OSHA provides a great resource for Root Cause Analysis here.

Improving Your Company’s Near Miss Program

You’ve received a near miss, conducted an investigation, identified a true root cause, and took corrective action to eliminate it; now you see the tremendous benefit of near-miss reporting. Then ask what can you do to improve your company’s near-miss program?

1. Keep the reporting process simple.

Consider implementing google forms, phone applications, or even a universal near-miss email address. The key is to make the process to submit a near-miss as easy, quick, and painless as possible. For example, many companies now create QR codes that can be scanned, taking personnel right to the form to complete and submit. This can all be done for free with readily available resources around the internet.

2. Train employees on the importance of near-miss reporting.

If employees don’t recognize the importance of near-miss reporting, they will have no interest in doing so. Ensure that employees know the benefits of near-miss reporting.

3. Keep near-miss reports non-punitive.

No one wants to willingly broadcast their mistakes, especially if they will be punished for doing so. Punishing an employee who submits a near-miss report is a sure-fire way to send a message that safety may not rank as high on the priority list as you claim. This is also a guaranteed way to discourage employees from participating in the program. On the other hand, when near-miss reporting is rewarded, it can change their mindset.

4. Incentivize the program.

Even if employees know the benefits of a near-miss program and know that it will be non-punitive, they may still need a little encouragement to do so. Consider implementing a periodic drawing for all who submit near-miss reports. Alternatively, consider highlighting the best near-miss submitted for the month to promote quality participation.

5. Celebrate and communicate your success.

Perhaps the most important part of a successful near-miss program is communicating your findings and celebrating your success. Communication should be transparent but does not have to be so transparent that it includes every detail of the situation. Include highlights of the near-miss and the corrective actions that will be taken to prevent them in the future. Communicating your findings could help prevent other incidents as well.

Summary

When your employees know they can openly report an incident or mishap without being reprimanded, it can encourage more open communications and improved safety awareness. Most certainly, it gives you the opportunity to take corrective action and prevent a more serious injury, or worse. Actively promoting employee involvement via near-miss reporting will provide a boost to your overall safety program and result in a safer worksite for everyone. A “good catch” is a good catch for all concerned.

Chris McGlynn is a dynamic safety leader who serves as the Director of Safety at Roco Rescue and is dedicated to amplifying the company's safety success. As a Certified Safety Professional, Confined Space and Rope Rescue Technician, and Paramedic, Chris leverages his expertise to provide employees with the necessary tools, training, and support to work safely and efficiently. He also oversees Roco Safety Services, offering high-caliber safety professionals for special projects and turnarounds. As the VPP Coordinator, Chris ensures that Roco maintains its status as an OSHA VPP Star Worksite, continuing the company’s unwavering commitment to excellence in safety and health. Roco has been an OSHA VPP Star Worksite since 2013.

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Additional Resources

• Want a Safer Workplace? Get Employees Involved!

• How to Make an Impact as Safety Professionals

As a rescuer, it’s your worst nightmare. A person is trapped and the space is rapidly filling with water. That’s what rescuers faced recently in Westmont, IL.

A public works employee became trapped in an underground vault that was rapidly filling with water due to a water main break.

In a press release, the Village of Westmont said the worker was unresponsive when they were pulled from the underground water main vault at the intersection of 60th Street and Deming Place around 12:40 p.m., about an hour after first responders were called to the scene.

Nearby residents could only watch helplessly as a swarm of first responders mounted a desperate rescue effort.

"Everybody was running, frantic trying to get something done, doing what they were supposed to be doing. You could tell that it was, that it was pretty, an emergency situation from the very beginning," said Sue Jay, resident.

Lifesaving measures were administered and the worker was transported to Good Samaritan Hospital, where he was pronounced dead. The worker was identified by village officials as Matt Heiden.

"To lose somebody like that that you think is just going off to work for the day is sad," Jay said.

Officials said Heiden has worked for the village since 2019 and recently became a full time water maintenance worker. He attended Westmont High School, where he was a student athlete before graduating in 2020.

"Hard working, humble. He played baseball, and he was well-liked by his classmates, and his family is very admired by the Westmont community," said Principal Jack Baldermann.

Westmont officials released a statement expressing condolences to his family and loved ones. Flags were lowered to half-staff at the village hall. Baldermann said counselors will be on hand at the school in the morning.

An investigation has been launched into what happened and how Heiden became trapped.

Source: Eric Horng and ABC7 Chicago Digital Team.

See full story here: https://abc7chicago.com/westmont-il-news-public-works-worker-killed/12866995/

BRECKENRIDGE, CO – The owner of a Vail construction company facing felony manslaughter charges has surrendered to local law enforcement. This is related to the findings of a federal safety investigation into a deadly trench collapse in November 2021. A worker installing residential sewer pipes suffered fatal injuries when the trench around him caved in. The collapse resulted from deteriorating conditions at the project, which could have been prevented by using legally required trench protection systems.

OSHA issued three willful citations for not ensuring the excavation was inspected by a competent person, failing to instruct employees on the recognition and avoidance of unsafe conditions and not having a trench protective system in place. Investigators also issued an additional serious citation for not having a safe means of egress within 25 lateral feet of employees working in a trench.

“There is no excuse for failing to protect workers when federal requirements clearly outline and require safety measures proven to save lives,” explained Regional Solicitor of Labor John Rainwater in Dallas. “Today’s arrest cannot recover a life lost in this senseless tragedy but it is a step toward seeking justice for the family.”

Collapses and cave-ins pose the greatest threat to trenching and excavation workers. In 2022, OSHA reported that at least 39 industry workers died, 22 of them in the first six months of the year. The Bureau of Labor Statistics reports that 166 workers died in trench collapses from 2011 to 2018.

“Let this tragedy serve as a reminder to other employers who willingly fail in their responsibilities to keep workers safe that the U.S. Department of Labor will exhaust every resource to hold employers accountable for protecting workers, including recommending criminal prosecution.”

OSHA has a National Emphasis Program on trenching and excavations. Trenching standards require protective systems on trenches deeper than 5 feet. Additionally, trenches must be inspected by a knowledgeable person and have a safe means of entering and exiting prior to allowing a worker to enter.

Additional Resources

If you’re concerned that your rescue service may not be adequately prepared, give us a call or check out these resources for more information on how to keep you and your personnel safe around trenches.

• Trench Safety & Rescue Article: Read More
• Trench Training: Competent Person | Trench Rescue Technician
• OSHA’s Trenching and Excavation Webpage

We are often asked, “How should I clean my rescue rope?”

First and foremost, always follow the manufacturer’s recommendations for cleaning and caring for your rescue rope. Your rope is a critical link in your rescue system, and it should be treated accordingly.

Excessive dirt and grit on your rope can lead to wear that reduces a rope’s strength and lifespan – so it’s important to clean your rope when needed. 

Here’s what NFPA 2500 says about cleaning and decontaminating rope:

Ref: NFPA 2500: Standard for Operations and Training for Technical Search and Rescue Incidents and Life Safety Rope and Equipment for Emergency Services, 2022 Edition - Chapter 32 Cleaning and Decontamination (NFPA 1858)

32.2.3 Routine Cleaning Process for Life Safety Rope and Webbing

32.2.3.1 The organization shall determine its requirements for when rope or webbing shall be cleaned.

32.2.3.2 In the absence of manufacturer's instructions, the cleaning procedure shall be as follows:

1. Remove as much debris, dirt, and mud as possible at the scene.
2. Rinse off any excess dirt with a hose.
3. Soak the rope or webbing for a minimum of 30 minutes in a plastic tub of water with mild detergent added.
4. Rinse the rope or webbing by pulling it through a rope washing device twice.
5. Hang the rope or webbing in a cool, shady place to dry.

32.2.4 * Decontamination of Rope and Webbing (* references additional information in the Appendix)
(A.32.2.4 Biohazard cleaning agents can have an adverse effect on the strength of software products. The organization should determine the risk versus benefit of excessive decontamination of rope. At some point, it is best to take the rope out of service.)

32.2.4.1 The organization shall determine requirements pertaining to rope or webbing being taken out of service due to contamination.

32.2.4.2 Rope or webbing that has come into contact with blood or other body fluids shall be decontaminated using detergents or cleaning agents approved for removing biohazards according to the organization’s protocols for decontaminating PPE.

Here’s what PMI says about cleaning and decontaminating rope:

WASH IT – You can wash dirty ropes by hand or in a front-loading commercial washing machine using cold to warm water with a mild soap. Non-detergent soaps are best. Soap should not contain any bleaching agents. And PMI has a product called “Rope Soap” that is recommended.

PMI recommends that top loading washing machines with agitators not be used – they tend to tangle the rope and might even cause damage from friction produced by rubbing of the synthetic rope against the synthetic agitator.

It’s also important to note that ropes may shrink up to 6% after washing – you may want to verify rope length periodically.

LUBRICATE IT – Ropes may dry out and lose some flexibility after washing. Occasionally, you can add a small amount of fabric softener (about a cup) to the rinse cycle. Do not use more than this as it may damage your rope.

DRY IT – Dry your rope in a clean, dry area out of direct sunlight. For best results, it should be laid in a loose coil or coiled around two objects in a low-humidity environment.

AVOID:

1. Using a commercial dryer.
2. Placing wet ropes on a concrete surface.
   (Moisture in the concrete can create a mild acid vapor.)
3. Exposure to exhaust fumes.

And, write it down. Remember to record the cleaning on your rope log.

STORE IT SAFELY – Store your rope in a clean, dark, dry environment, away from exposure to acids, other harmful chemicals, noxious fumes or other abuse. Make sure it is completely dry before storing.

Note: Even properly stored rope can lose strength over time, so it’s critical to store it properly!

DECONTAMINATION – Disinfection of a rope may occasionally become necessary, such as when exposed to bloodborne pathogens. PMI recommends following the NFPA standard for cleaning rescue gear of bloodborne pathogens.

Prepare a solution of 60ml (approximately ¼ cup) of household bleach for every 4 liters of tap water (approximately 1 gallon). Soak the rope for 10 minutes in the solution and then rinse or wash the rope. The rinsing cycle is critical to prevent any damage to the rope from the bleach.

Note: It is vital that the bleach be thoroughly rinsed from the rope. And, repeated uses of bleach can cause damage to nylon fibers – use of bleach to disinfect should be used sparingly and only when needed.

Again, your rope is a critical part of your rescue system. It deserves your close attention in care, storage, cleaning, use and inspection. And, as always, if there’s any doubt – throw it out!!

Additional Resources

• Service Life of Rescue Equipment
• How often should I replace my rescue harness?
• Marking Rescue Hardware
  
  
  

The U.S. Department of Labor issues an OSHA National News Release that announces new enforcement guidelines that could exponentially increase penalties for companies who prioritize profits over safety. Specifically, OSHA addresses the expanded application of instance-by-instance citations and non-grouping of violations in certain cases that will go into effect on March 27th of this year.

Originally published in October 1990, CPL 02-00-080, also known as the “egregious or violation-by-violation penalty procedure,” was intended to “create large aggregate penalties” for willful citations in order to “provide an incentive to employers to prevent safety and health violations in their workplace”. In the first memo, OSHA expands the scenarios that “instance-by-instance” citations may be issued for “high-gravity serious violations of standards specific to falls, trenching, machine guarding, respiratory protection, permit-required confined spaces, lockout tagout, and other-than-serious violations specific to recordkeeping”. If you haven’t noticed, these closely align with OSHA’s “Top 10 Most Frequently Cited Standards”. The scope of this directive applies to general industry, construction, maritime, and agriculture; in other words, this applies to everything under OSHA’s jurisdiction.

So, what does the expanded use for instance-by-instance citations include?

According to OSHA, a decision to use instance-by-instance should be based on the consideration of one or more of the following factors and does not preclude the use of other OSHA initiatives, directives, or emphasis programs.

• The employer has received a willful, repeat, or failure to abate violation within the past five years where that classification is current.
• The employer has failed to report a fatality, inpatient hospitalization, amputation, or loss of an eye pursuant to the requirements of 29 CFR 1904.39.
• The proposed citations are related to a fatality/catastrophe.
• The proposed recordkeeping citations are related to injury or illness(es) that occurred as a result of a serious hazard.
  
  

This is intended to be a targeted strategy for those employers who repeatedly choose to put profits before their employees’ safety, health and well-being.

According to statements released by Doug Parker, Assistant Secretary for OSHA, “Smart, impactful enforcement means using all the tools available to us when an employer ‘doesn’t get it’ and will respond to only additional deterrence in the form of increased citations and penalties.” He goes on further to state that “This is intended to be a targeted strategy for those employers who repeatedly choose to put profits before their employees’ safety, health and well-being. Employers who callously view injured or sickened workers simply as a cost of doing business will face more serious consequences.”

References

https://www.osha.gov/news/newsreleases/national/01262023-0

https://www.osha.gov/enforcement/directives/cpl-02-00-080

https://www.osha.gov/memos/2023-01-26/application-of-instance-by-instance-penalty-adjustments

https://www.osha.gov/top10citedstandards

https://www.osha.gov/memos/2023-01-26/exercising-discretion-when-not-to-group-violations

https://www.osha.gov/enforcement/directives/cpl-02-00-164/chapter-4

Additional Resources

• Want a Safer Workplace? Get Employees Involved!

• How to Make an Impact as Safety Professionals