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Figure 1-6.—Mishap report format. | Up
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CHARLIE:
REPORTABLE INJURIES
7. FATALITY OR EXTENT OF INJURIES OR OCCUPATIONAL ILLNESSES (Specify if
fatality, missing, permanent total disability, permanent partial disability, or no disability likely.)
8. ESTIMATE OF LOST TIME
A. TOTAL LOST WORKDAYS AWAY FROM JOB
B. DAYS ACTUALLY HOSPITALIZED
DELTA
1. CAUSE OF MISHAP (Personnel error, unsafe condition, improper procedures, material failure
improper design, environment, unknown or combination of the above. Elaborate in the narrative and explain how
each factor contributed to the mishap. Complete items 2 through 4 only if personnel error is involved.)
2. WHO CAUSED THE MISHAP (supervisor or foreman, operator, maintenance worker,
off-duty military, other or unknown.)
3. WHAT DID HE/SHE FAIL TO DO? (Correctly operate controls; perform PMS or maintenance
properly; recognize hazardous situation; use proper caution for know risk; use protective clothing or equipment,
use proper tool or equipment; plan adequately; supervise progress of work; or other.)
4. WHAT DID HE/SHE FAIL TO CARRY OUT ACTION OF DELTA 3? (Lack of
concern/interest; distracted or inattentive; haste; overconfidence; emotionally aroused; inadequate knowledge;
insufficient experience; fatigue; alcohol; drugs; illness; misunderstanding; design; or other.)
5. ESTIMATED SHIP OPERATING DAYS LOST
6. ASSOCIATED MESSAGES (If not included under referents.)
ECHO:
NARRATIVE: Chain of events leading up to, through, and subsequent to mishap; if five give class
(A, B, C, D), source and how extinguished-water, fog, C02, PKP, AFFF, Halon, protein foam, other (specify). If
flooding, give source and how denatured (installed eductor system, portable eductor, submersible pump, P-250,
other (specify). If collision, give estimate of damage and identification of other ship or structure; give
commendations; lessons learned; elaborate with remarks so that the who, what, where, when and how of the
mishap is known.
Figure 1-6.—Mishap report format—Continued.
6. Part of body affected. Did the injury involve an
arm, legs, ribs, feet, fingers, or head?
These categories suggest some of the things, but
not all of those you must investigate and report when
mishaps occur.
Remember, there are some questions in these
categories that require medical information that can
only be obtained from a doctor. Each mishap is
different, and each is to be investigated and judged on
its own merits. Do not jump to conclusions. Start each
investigation with an open mind. The most important
reason for any mishap investigation is to prevent
similar ones from occurring.
HEARING AND SIGHT
CONSERVATION
The Navy’s goal is to prevent occupational
hearing and sight loss within the workplace and to
assure that the exposure of members to potential
hazardous noises and eye hazards are held to a
minimum. The Navy’s policy is also to provide the
necessary medical care, surveillance, documentation,
and treatment to all personnel.
Hearing Conservation
Environments that produce potentially hazardous
noise should be modified to reduce the noise level to
acceptable levels whenever it is technologically and
economically feasible. The reduction of noise at the
source is in the best interest of the Navy and its
personnel. The Navy’s Hearing Conservation Program
includes the following recommendations:
Work environments are to be surveyed to
identify any potentially hazardous noise
levels.
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