6709.12_30
Page 1 of 9
FOREST SERVICE HANDBOOK
KAIBAB NATIONAL FOREST
WILLIAMS, ARIZONA
FSH 6709.12 – SAFETY AND HEALTH PROGRAM HANDBOOK
CHAPTER 30 – ACCIDENT INVESTIGATION AND REPORTING
Supplement No.: 6709.12-2002-1
Effective Date: August 27, 2002.
Duration: This supplement is effective until superseded or removed.
Approved: MICHAEL R. WILLIAMS
Forest Supervisor
Date Approved: 08/27/2002
Posting Instructions: Supplements are numbered consecutively by Handbook number and
calendar year. Post by document; remove the entire document and replace it with this
supplement. Retain this transmittal as the first page(s) of this document. The last supplement to
this Handbook was 6709.12-98-1 to 30-35.
New Document
6709.12_30
9 Pages
Superseded Document(s) by
Issuance Number and
Effective Date
6709.12_30-35
(Kaibab supplement 6709.12-98-1,
dated October 2, 1998)
8 Pages
Digest:
32.1 – Identifies Kaibab National Forest accident notification criteria and process.
33 – Formally incorporates existing accident notification procedures on the Kaibab National
Forest into handbook and establishes Kaibab Forms 07-6700-01 (Notification of Accident or
Injury) and 07-6700-04 (Safety Incident Report).
34 – Establishes flow charts to assist in the accident/injury reporting process.
35.3 – Identifies specially trained Forest individuals to investigate accidents as documented in
the Kaibab National Forest Safety Plan.
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 08/26/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
Page 2 of 9
FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
Digest -- Continued:
36 - Provides Forest supplementation to national accident investigation procedures. The three
exhibits are provided to aid in following the proper reporting procedure. Establishes Kaibab
Form 07-6700-06 (Motor Vehicle/Property Damage Case Report Transmittal) and establishes
internal procedures for routing formal accident/incident case reports.
33.2 Exhibit 01 - Incorporates a flow chart outlining the process for reporting a Personal Injury
Accident as Exhibit 01.
33.2 Exhibit 02 - Incorporates a flow chart outlining the process for reporting a Motor Vehicle
Accident as Exhibit 02.
33.2 Exhibit 03 - Incorporates a flow chart outlining the process for reporting a Property
Damage Accident as Exhibit 03.
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 08/26/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
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FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
32 - ACCIDENT NOTIFICATION
32.1 – Kaibab National Forest Notification Criteria And Process.
1. All major work related accidents, injuries, or illnesses must be reported to the
immediate supervisor, who will in turn notify the Unit Head (District Ranger/Forest Staff
Officer). In case of minor accidents, injuries, or illnesses, report these incidents to the
immediate supervisor or crew leader, at a minimum.
2. When vehicle accidents or property damages exceed $1000 or personal injuries are
severe, such as broken bones, serious illnesses, hospitalization, or fatality, additional
notifications must be completed (Sec. 32.1, Exhibits 1-5). Procedures for making these
notifications are as follows:
a. The Kaibab Forest Dispatcher will be notified by radio or telephone.
b. The Kaibab Dispatcher will notify the Forest Safety Officer (Forest Supervisor)
and notify the affected unit District Ranger and the Kaibab Safety & Health
Coordinator.
c. If a serious injury is associated with any accident, the Kaibab Dispatcher will
contact the Zone Compensation Officer in Human Resources.
d. The Kaibab Dispatcher will first attempt to contact one of the above Forest
individuals. If successful, that individual will make the Region and/or Chief
notifications. If unsuccessful, the Kaibab Duty Officer will be contacted and
will notify the Region or Chief’s Office. Refer to FSH 6709.12, Sections 32.1,
32.2, and Accident Investigation & Reporting Guide (April 2000).
REGION 3 CONTACTS ARE:
Safety & Occupational Health
Manager
(James Rawlinson)
Regional Aviation Safety Officer
(Larry Hindman)
OFFICE PHONE
CELLULAR PHONE
505-842-3393
505-301-1294
505-842-3351
505-450-8504
WASHINGTON OFFICE CONTACTS ARE:
OFFICE PHONE
703-235-8102
Human Resources - Health & Safety
ext. 3135
Program Coordinator
(Ronald Wilson)
PAGER
800-759-7243
(pin 805*6118)
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 08/26/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
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FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
33 – ACCIDENT REPORTING
33.1 – Kaibab National Forest Accident/Incident Notification Process. All work related
vehicle and property accidents, personal injuries and illnesses must be reported to the
immediate supervisor and the immediate supervisor will in turn notify the District Ranger
and/or Forest Supervisor. Minor personal injuries need only be reported to the immediate
supervisor or crew leader. These individuals may use discretion of upward notification,
however, if there is any doubt, notify next higher-level manager. However, one of the
following Kaibab Forms; 07-6700-01 (Notification of Accident or Injury) or 07-6700-04
(Safety Incident Report) will be utilized on the Kaibab National Forest to report all work
related accidents, property damage, injuries, or illnesses.
1. Kaibab Form 07-6700-01, (Notification of Accident or Injury), will be used to report
vehicle accidents and/or property damages exceeding $350 damage or a personal injury
requiring medical treatment. Supervisor or designee must make e-mail notification
within 2 days to the "pdl r3 kaibab accidents" mailing list (sec. 32.1). The “pdl r3
kaibab accidents” e-mail mailing list includes the Forest Supervisor, Kaibab District
Rangers, Forest Safety & Health Coordinator, Administrative Officer, Hazard Materials
Coordinator, Financial Officer, Personnel Officer, Law Enforcement Officer, and
Forest Safety Committee members.
2. Kaibab Form 07-6700-04, (Safety Incident Report) will be used to report vehicle
accidents or property damage less than $350, or a minor personal injury or a first aid
injury not requiring medical treatment, or to report a “near miss” situation, such as
detecting a hazardous situation or event, a procedure, or equipment dysfunction that
resulted in a near miss accident. Either make an e-mail notification or send a hard copy
to the Kaibab Forest Safety & Health Coordinator.
34 – ACCIDENT INVESTIGATIONS
All work related accidents, regardless of severity, require some degree of investigation. The
Unit Manager (District Ranger or Staff Officer) is responsible for assuring that all accidents are
properly investigated, all necessary forms and reports are completed, and that forms and
reports are transmitted as stated below in Section 36. As a minimum, a memo documenting the
investigation should be submitted with forms specified in flow charts, Section 33.2, Exhibits
01-03.
The flow charts contained in Section 33.2, Exhibits 01, 02, and 03 are designed to provide
guidance in the procedures for notification, investigation, and reporting of accidents.
1. Exhibit 01 is for personal injury accidents and occupational illnesses,
2. Exhibit 02 is for motor vehicle accidents, and
3. Exhibit 3 is for property damage incidents/accidents.
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 08/26/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
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FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
The exhibits are not mutually exclusive. Often, an accident involves personal injury, property
damage, and motor vehicles. In such a case, the procedures of all three exhibits are applicable.
Proper use of the exhibits requires that all three be reviewed and that any applicable paths
identified be followed until all procedures have been completed. All formal reports will be
mailed to the Personnel Officer, who will insure that reports are properly completed.
For minor accident investigation, the unit manager may delegate these responsibilities on a
case-by-case basis, however, for very severe accidents, the unit manager should immediately
begin an investigation and continue until the responsibility for accident investigation and
reporting is taken over by higher organizational levels.
35 – INVESTIGATION PROCEDURES
35.3 – Team Composition. Individuals specifically trained to investigate accidents on the
Kaibab National Forest shall be listed in the Kaibab National Forest Safety Plan. Those
individuals and the affected unit’s first-level line officer shall immediately begin an
investigation and continue until the responsibility for investigation and reporting is assumed by
higher organizational levels.
For minor injury, illness, or property damage accidents, a single investigator may often suffice.
This may be the first line supervisor or delegated to the next lower level manager or a
supervisor position.
36 – FOREST SERVICE ACCIDENT INVESTIGATION REPORTS
The Kaibab National Forest will utilize Kaibab Form 07-6700-06 (Kaibab NF Motor
Vehicle/Property Damage Case Report Transmittal) for internal distribution for motor
vehicle/property damage case reports. The following individuals will review case reports:
1. Safety & Health Coordinator - Reviews case report.
2. Fleet Equipment Manager - Reviews motor vehicle accident reports.
3. Road System Manager - Reviews accidents on Forest roads.
4. Property Management Officer - Determines negligence (coordinates with Fleet
Equipment Manager, Health and Safety Coordinator, and others as necessary) and
indicates decision on AD-112.
5. Administrative Officer – Makes determination on financial liability.
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 08/26/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
Page 6 of 9
FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
6. Personnel Officer - Reviews Property Management Officer's determination and follows
up with Forest Supervisor on disciplinary action/financial responsibility.
7. Budget & Finance Officer - Makes copy for claim file as needed, indicates action taken
on AD-112.
8. Personnel Section Representative - Receives Case File for filing and sends a copy of
the completed case to RO-HR; returns copy of AD-112 to submitting unit; and posts
closure to Accident Report Log.
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 02/02/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
Page 7 of 9
FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
33.2 – Exhibit 01 - Flow Chart for Personal Injury Accidents
Responsible Officer
Determines initial
Level of investigation
IBM Notification
Fatal
Notify Forest
Supervisor
Immediately
See
FSH 6709.12
Ch. 32.1
Fatal or
Employee
Severity
Severe
Who
Involved
?
Private
Severity
Other
Complete
Appropriate
Notification
Other
Occupational
Illness CA-2
Claim
Potential
Investigation Report
Traumatic
Injury CA-1
CA-1
To Personnel
NO
Dr.
Needed
?
YES
APMC Case
FS 6100-16
Send to
Program Phys.
Lost
Time
?
NO
YES
Complete CA-2
& Appropriate
Checklist for
Determination
By OWCP *
FS-6700-8
Invest. Report per
FSH 6709.12
*Initial doctor visits are the employees responsibility,
until such time as OWCP makes a ruling in the case.
YES
More
than follow-up
visit needed
High
OWCP Case
CA-16
CA-17
OWCP-1500
NO
Send all paperwork
To Personnel
Low
FS-6700-8 Report
of Incident to Other
Than Employees
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 02/02/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
Page 8 of 9
FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
33.2 – Exhibit 02
Flow Chart for Motor Vehicles Accidents
MOTOR
VEHICLE
ACCIDENTS
Responsible Officer
Determines initial
Level of investigation
IBM Notification
NO
Appearance
Of Negligence?
Govt.
Vehicles
Involved
YES
SF-91
AD-112
>$350.00
Fleet Manager’s
Damage Estimate
<$350.00
SF-91 – Operator’s Report
SF- 91A-- Investigation Report of MVA
SF-94 – Statement of Witness
AD-112—Report of Damaged Property
Private
Low
Claim
Potential
High
Investigation
Team
FS-6700-8
Invest. Report per
FSH 6709.12
Investigation
Report
Send all paperwork to
Personnel &
Attn: Health and
Safety Coordinator
FS-6700-8 Report of
Incident to Other
Than Employees
KAIBAB NF SUPPLEMENT 6709.12-2002-1
EFFECTIVE DATE: 02/02/2002
DURATION: This supplement is effective until superseded or removed.
6709.12_30
Page 9 of 9
FSH 6709.12 – SAFETY AND HEALTH PROGRAMS HANDBOOK
CHAPTER 30 - ACCIDENT INVESTIGATION AND REPORTING
33.2 – Exhibit 03
Flow Chart for Property Damage
PROPERTY
DAMAGE
Responsible Officer
Determines initial
Level of investigation
IBM Notification
NO
Appearance
For negligence?
Severe?
Govt.
AD-112
Property
Ownership
?
Private
Claim
Potential
High
YES
Investigation
Report
Documents
To Personnel
Employee
AD-358 Employee Claim
Supervisor’s Statement
Witness Statement
FS-6700-8
Invest. Report per
FSH 6709.12
Low
FS-6700-8 Report of
Incident to Other
Than Employees