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Page Title: INVESTIGATIVE PROCEDURES
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Chapter 8 Safety and Damage Control
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CAUSE  FACTORS

it  is  the  result  of  the  mishap.  The  cause  of  a mishap  is  usually  discovered  during  an  investiga- tion  of  an  injury  or  damage. DEFINITIONS Before  continuing,  let’s  define  some  of  the terms with which you as an investigator need to be  familiar: Mishap —Any  unplanned  or  unexpected  event causing  material  loss  or  damage  or  causing personnel injury or death; or an occurrence that, except for proximity or timely action, would have resulted  in  damage  or  injury. Mishap  investigation  —A  check  of  the  facts surrounding  the  causes  of  a  mishap;  conducted by  the  command  involved  using  the  procedures outlined  in  OPNAVINST  5102.1C. JAG  Manual  investigation  —A check that provides   official,   factual   documentation   of   all matters pertaining to a mishap, which can be used for  legal  or  administrative  action. Naval Safety Center investigation —An  inde- pendent check conducted based on the guidelines of  a  mishap  investigation.  It  is  in  addition  to, but not a substitution for, either a JAG Manual investigation  or  the  mishap  investigation  conducted by  the  local  command. Protection of information  —The  requirement that  prevents  individuals  who  are  conducting  a separate   mishap   investigation   from   divulging information   obtained   or   from   providing   an opinion  based  on  that  information  to  any  other fact-finding  body.  The  limitations  on  the  use  of statistical mishap reports. The prevention of any part   of   Personnel   Injury/Death/Occupational Illness Report (OPNAV Form 5102/1) or Material (Property)   Damage   Mishap   Report   (OPNAV Form 5102/2) being used in any other investiga- tion.   Protection   of   information   is   based   on OPNAVINST  5102.1C. INVESTIGATIVE  PROCEDURES Your investigation should answer the questions of  What?  Where?  When?  How?  and  Why?  Your investigative  procedures  should  be  geared  toward these questions as well. You should begin your investigation as soon as  possible  after  the  mishap.  The  sooner  you begin,   the   better   the   investigation   will   be. Witnesses  will  be  present.  More  accurate  facts  can be  gathered  because  of  the  possibility  that  the damage or materials should be in the same relative position  as  when  the  mishap  occurred. You  will  have  very  little  time  to  plan  your investigation.  You  should  be  ready  to  proceed with  the  collection  of  facts  and  circumstances  with little  prior  notification. Real evidence, such as photographs, records, operating  logs,    and   damaged   equipment   or material, can be shared by the investigative bodies. Items  that  fail  to  meet  military  or  manufacturer’s standards should be marked for investigation by the  appropriate  technical  authority. Photographs  can  provide  invaluable  evidence. They should be clear and provide enough detail to  actually  depict  the  situation.  Color  photographs should  be  used  if  possible,  but  black  and  white will  suffice.  Polaroid  instant  prints  present  an accurate  representation  of  the  scene.  However, Polaroid type prints are difficult to reproduce or enlarge.  You  should  take  the  photographs  from at least two different angles and use a ruler in the photographs  to  show  exact  dimensions. Sketches  may  be  used  instead  of  or  in conjunction  with  photographs.  Sketches  should be   drawn   to   scale.   Use   graph   paper   if   it   is available. Pieces  of  equipment  or  material  should  be carefully handled to ensure physical evidence is not destroyed. Each item should be tagged with a full descriptive relationship to the accident. A photograph  or  sketch  should  be  included  with items sent out for laboratory testing to show the “as   found”   location   or   condition. Verbatim  copies  of  operating  logs,  records, directives,  and  so  forth,  should  be  made.  If possible, make a photocopy or photograph. Make notations  of  obvious  erasures  and  mark-overs, and  make  sure  the  notations  appear  in  the  photo- copy   or   photograph. Since  testimony  in  a  safety  investigation  is unsworn,  all  verbal  information  must  be  fully evaluated.  You  should  always  remember  that  this information is to be used for the single purpose 8-2

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