OSHA Instruction CPL 2.64 JUN 5 1985 Directorate of Field Operations

Subject: Implementation of a Construction Fatality Information Dissemination System

A. Purpose. This instruction makes permanent a pilot project which has been in effect for over a year wherein summaries of the results of OSHA construction fatality or catastrophe investigations have been prepared and disseminated to interested parties or groups.

B. Scope. This instruction applies OSHA-wide.

C. Action. Regional Administrators and Area Directors shall ensure that the Procedures established in this instruction are adhered to for all construction fatality and catastrophe investigations.

D. Federal Program Change. This instruction describes a Federal program change which affects State Programs Each Regional Administrator shall:

1. Ensure that this change is promptly forwarded to State designees.

2. Explain the technical content of this change to the State designees as requested

3. Notify the State designees that they are encouraged but not required to participate in this program.

4. Ensure that State designees are asked to acknowledge receipt of this Federal program change in writing, within 30 days of notification, to the Regional Administrator. This acknowledgment should indicate the State's intent with regard to participation in the program. If the State

OSHA INSTRUCTION CPL 2.64 JUNE 5 1985 DIRECTORATE OF FIELD OPERATIONS

chooses to participate, it should coordinate with the Regional Administrator the procedure for submitting construction fatality or catastrophe investigation summaries to the Region.

E. Background. OSHA investigates some 1600 fatal accidents during the average year. Valuable data related to these accidents are collected and placed in the case files addressing the cause of the accidents and also the means, including the corrective action, whereby such accidents could be prevented in the future. Prior to the development of the pilot project, most of that potentially valuable and instructive material remained buried in the case file. It was not easily available even to the agency itself.

1. The pilot project was designed to allow this information to be widely disseminated to interested parties or groups, including OSHA's National Office.

2. The pilot project has been in effect in all Regions for construction fatalities and catastrophes only. Agency experience has been very positive, and the decision has been made to implement the system permanently.

F. Procedures. Each Regional Administrator shall be responsible for the development of the summaries and for their transmission to the National Office for possible dissemination.

1. Area Directors and Area Office staff shall be adequately briefed on the goal of the project.

2. After a construction fatality or catastrophe investigation shall have been completed, the Area Director, using the attached format, shall be responsible for writing a summary of the investigation findings That summary shall include the following elements:

OSHA INSTRUCTION CPL 2.64 JUNE 5 1985 DIRECTORATE OF FIELD OPERATIONS

a. A rough sketch and/or Photographs depicting what happened and a brief narrative description of the events of the accident keyed to the sketch;

b. A short Paragraph analyzing the hazards involved, the standard apparently violated and the apparent causes of or related factors contributing to the accident;

c. A recommendation of appropriate corrective actions by which the accident could have been prevented or a recurrence of a similar accident could be avoided.

3. The summary shall not be forwarded to the Regional Office by the Area Office staff until the case has been closed. At least one such summary shall be forwarded each month.

4. Personal identities and the names of the companies involved shall not be used in the summary.

5. Although the Area Director is responsible for writing the first draft of the summary, the Regional Administrator shall ensure that the summary sent to the National Office is of good quality and meets the project goals.

a. Regional Administrators shall screen the summaries received from the Area Offices and select those to be forwarded to the National Office for possible publication.

b. At least one but no more than two such summaries shall be forwarded by each Regional Administrator per month. Those judged to have the widest interest and greatest accident prevention potential should be given highest preference in the selection process.

c. Regional Administrators shall begin sending summaries to the National Office on the last day of the first full month following the publication of this instruction.

OSHA INSTRUCTION CPL 2.64 JUN 5 1985 DIRECTORATE OF FIELD OPERATIONS

6. A format for the summary page is attached to this instruction. A sample copy of a published report is also attached for your information.

7. The Regional Administrator shall transmit the selected summaries within 30 days of receipt of the Area Office draft to the Office of Construction and Maritime Compliance Assistance, Directorate of Field Operations.

8. The Office of Construction and Maritime Compliance Assistance shall review and evaluate the summaries received from the Regions. The summaries to be published shall then be selected and forwarded to the Office of Information and Consumer Affairs (OICA), Attention: James Foster.

9. Publication and distribution will be made by OICA from a permanent mailing list. The names and addresses of all parties to be placed on the initial distribution list must be received by the tenth of the month following the publication of this instruction. Names to be added to the list must be received in OICA by the tenth of the following month to be included on the distribution list for that month.

a. To help in controlling expenses, only those parties which can be expected to make additional distribution through other channels of their own should be included. OSHA encourages the use of bulk mailing for accident summaries. Thus, for example, multiple copies will be furnished to any group wishing to distribute them with their own newsletter or in other mailings to members.

b. Distribution will also be made to all recipients of this instruction. (See DISTRIBUTION.)

OSHA INSTRUCTION CPL 2.64 JUN 5 1985 DIRECTORATE OF FIELD OPERATIONS

10. Regional Administrators, Area Directors and any other recipient of the summaries may use them in any way they choose. They are not copyrighted, and permission is not required to reproduce them. Users are requested, however, to credit OSHA, U.S. Department of Labor.

11. OICA will not stock back issues of the published summaries. For this reason each field office is encouraged to maintain a file set so that copies can be made if needed later.

Robert A. Rowland Assistant Secretary

DISTRIBUTION: National, Regional and Area Offices State Designees 7(c)(1) Project Managers NIOSH Regional Program Directors New Directions Grantees All Compliance Officers

OSHA INSTRUCTION CPL 2.64 JUN 5 1985 DIRECTORATE OF FIELD OPERATIONS

Accident Type: Weather Conditions: Type of Company: Size of Work Crew: Union or Non-Union: Worksite Inspections Conducted (1926.20(b)(2)): Designated Competent Person on Site (1926.20(b)(2)): Employer Safety and Health Program: Training and Education for Employees (1926.21(b)): Craft of Deceased Employee: Age/Sex: Time of the Job: Time at the Task:

1.

2.

3.

OSHA INSTRUCTION CPL 2.64 JUN 5 1985 DIRECTORATE OF FIELD OPERATIONS

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ACCIDENT REPORT FATAL FACTS U.S DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION MAY 1985

ACCIDENT SUMMARY

ACCIDENT TYPE Fall/Impalement

WEATHER Clear

ESTABLISHMENT Siding Contractor

CREW SIZE 4

COLLECTIVE BARGAINING Yes

COMPETENT PERSON Yes

SAFETY AND HEALTH PROGRAM Yes

WORKSITE INSPECTION Yes

TRAINING AND EDUCATION PERFORMED Yes

EMPLOYEE CRAFT Laborer

AGE/SEX 22-M

TIME ON JOB Two Weeks

TIME AT TASK N/A

A laborer working on a house under construction fell through a roof opening when a truss beam gave way. He fell about eight feet onto a patio foundation with half-inch, unprotected rebars protruding straight up about 20 inches from recently poured concrete. The laborer was impaled by one of the bars.

PREVENTATIVE STEPS

1. Prohibit employees from working above vertically protruding rebars unless the rebars are shielded or otherwise protected to prevent impalement as required by general provisions of OSHA's construction standards for reinforcing steel bars(29 CFR 1926.700).

2. Instruct each employee on how to recognize and avoid unsafe conditions and be sure he/she is aware of the regulations which apply to the work and the work area to eliminate safety and health hazards as required in the safety training and education section of OSHA's construction standards(29 CFR 1926.21).

For further information contact: Kansas City Regional Office (816) 374-5861