Par.

1. Purpose

2. Issuance Affected

3. Policy

4. Objective

5. Responsibilities

6. Reports

7. Direct Construction Contracts

8. Chargeability of Accidents

9. Tort Claim

10. Forms

1. PURPOSE. This Order prescribes recordkeeping procedures for accident reporting and investigation to comply with the Department of Transportation Safety Management Information System program and policy.

2. ISSUANCE AFFECTED. This Order supersedes Administrative Manual Volume 40, Accident Prevention, Chapter II, Accident Reporting, dated May 2, 1975.

3. POLICY. The Associate Administrators, Staff Office Directors, Regional Administrators, and Regional Engineers shall investigate and report all occupational accidents which occur in operations internal to FHWA, and in operations involving contractors and visitors to FHWA facilities.

4. OBJECTIVES

   1. To facilitate DOT and the Occupational Safety and Health Administration reporting requirements.

   2. To avoid duplication of effort in recordkeeping.

   3. To standardize loss analysis methods.

   4. To provide the Federal Highway Administration with timely and significant loss data.

5. RESPONSIBILITIES

   1. The Associate Administrators, Staff Office Directors, Regional Federal Highway Administrator and Regional Engineer shall ensure that:

      (1) FHWA employees notify their supervisors promptly of any accident in which they are involved in connection with their work, regardless of the degree of severity,

      (2) FHWA supervisors investigate and prepare the required reports within 24 hours of each accident involving their employees, or visitors to locations under their supervision, and

      (3) in the event of a major accident, a board of investigation is appointed according to procedures outlined in paragraph 5 of this Order.

   2. Occupational Safety Managers shall ensure that:

      (1) accident reports are complete and accurate, and that Appropriate Data Processing (ADP) codes are entered,

      (2) original copies of accident reports are forwarded to the Occupational Safety Staff, HMS-4, within five working days,

      (3) corrective action is implemented to ensure the elimination of the possibility of further occurrences,

      (4) logs are maintained of Federal Occupational Injuries and Reports (OSHA Form 100) and coordinated with the Injury Compensation Officer to ensure that accident reports are received for claims submitted on CA series personnel forms and that actual length of disability and final disposition are known,

      (5) quarterly reports (OSHA 102F/FF) are completed and forwarded to the Occupational Safety Staff, HMS-4, no later than 15 days after each calendar quarter ends, and

      (6) direct construction accidents are processed according to paragraph 6 of this Order, and forwarded to the Occupational Safety Staff, HMS-4, within five working days.

   3. Contracting Officers shall ensure that accidentsinvolving contractor operations at direct construction sites or facilities under FHWA control will be reported and investigated according to paragraph 6 of this Order.

6. REPORTS

   1. Major Accidents. All occupational accidents which result in loss of life, hospitalization of five or more employees, or property damage in excess of $100,000 shall be immediately telephoned by the Regional Safety Manager to the Headquarters Occupational Safety Staff, HMS-4, within 4 hours after such death or property damage is known to have occurred. This should be followed by a wire message within 48 hours containing:

      (1) the date, time place of accident,

      (2) in the event of loss of life, the name, age and address of victim and time of death, and

      (3) a brief description of the circumstances surrounding the accident.

      After the initial message following the accident, a board of investigation composed of no fewer than three individuals will be appointed by the Associate Administrator, Staff Office Director, Regional Administrator or Regional Engineer, as appropriate. The board will complete a narrative report of the accident, concluding with recommendations to prevent the occurrence or similar accidents. The report will be forwarded in duplicate through the Regional Federal Highway Administrator to the Headquarters Occupational Safety Staff, HMS-4. The Associate Administrator, Staff Office Director, Regional Federal Highway Administrator or Regional Engineer will state on the forwarding endorsement what corrective action has been taken.

   2. INJURY ACCIDENTS. All job related injuries, regardless of severity, will be reported on DOT F3902.1 Accident Report and DOT F3902.2, Injury Report, Supplement 1. The forms (original and one copy) should be filled out by the employee's supervisor within 24 hours and sent to the Regional Safety Manager. The original shall be forwarded within 5 working days following the date of the accident to the Headquarters Occupational Safety Staff, HMS-4.

   3. MOTOR VEHICLE ACCIDENT. For government motor vehicle accidents, DOT F3902.1 Accident Report and DOT completed (original and one copy) by the responsible supervisor within 24 hours and routed to the Regional Safety Manager via appropriate management officials. The Regional Safety Manager shall forward the original within 5 working days to the Headquarters Occupational Safety Staff, HMS-4. In addition, the operator of the vehicle is responsible for notifying the following, either in person or by telephone or telegram of any accident in which the vehicle is involved:

      (1) State, county, or municipal authorities, as required by law,

      (2) the employee's supervisor, who will then fill out GSA Standard Form 91 and GSA Standard Form 94 if applicable, or

      (3) the chief of the motor pool assigning the vehicle. When the operator is injured and cannot comply with the above requirements, the agency to which the vehicle is assigned shall arrange to notify the above parties.

   4. PROPERTY DAMAGE ACCIDENT. Government property damage shall be reported within 24 hours on DOT F3902.1 Accident Report and DOT F3902.4, Property Damage Report, Supplement P, by the responsible supervisor (original and one copy). The Regional Safety Manager is responsible for seeing that the original of this report is forwarded to the Headquarters Occupational Safety Staff, HMS-4, within 5 working days.

   5. FIRE OR EXPLOSION. Fires and/or explosions which occur in FHWA owned or leased facilities will be reported on DOT F3902.1 Accident Report and DOT F3902.5 Fire or Explosion Report, Supplement F within 24 hours of the accident. The responsible supervisor will prepare an original and one copy, to be forwarded by the Regional Safety Manager to the Headquarters Occupational Safety Staff, HMS-4, within 5 working days. In addition, DOT F3902.2 Injury Report, Supplement 1, shall be completed in the event that injuries are sustained.

   6. Log of Occupational Injuries and Illnesses. The Regional Safety Manager shall maintain a log of all occupational injuries and accidents using OSHA Form 100F, Log of Federal Occupational Injuries and Illnesses. Entries will be made upon notification of injury or illness, and retained for 5 years.

   7. Quarterly/Annual Report. The Occupational Safety and Health Administration (OSHA) Forms 102F, Summary Report of Federal Occupational Injuries and Illnesses, and 102FF, Summary Report of Federal Occupational Accidents are to be submitted at the end of each quarter and calendar year by the Regional Safety Manager and the Inter-American Highway Regional Engineer. These reports shall be sent to the Occupational Safety Staff, HMS-4,not later than 15 days after the end of the quarter and calendar year. Regional Safety Managers shall provide, in the "Comments" column, the date of injury, name of injured, extent of injury and the number of lost work days, if any. In the case of motor vehicle and/or property damage accidents, "Comments" will show the date of accident, person(s) involved and amount of damage.

7. DIRECT CONSTRUCTION CONTRACTS

   Reports. Reporting of accidents involving contractors' personnel and equipment engaged in direct construction contracts is prescribed in the special provisions of the contract, subsection 107.20, Construction Safety and Health Standards. It is intended that these reports be utilized by the FHWA engineers, in cooperation with the Regional Safety Program Manager, to locate hazardous conditions or work practices which do not meet contract safety requirements, in order that appropriate corrective action can be initiated. Accidents involving contractor operations at direct construction sites or facilities under FHWA control which result in death, occupational disease, disabling injury, or damage to property of $1,000 or more will be investigated by the Contracting Officer and reported on Form DOT 3902.1, Accident Report, with the appropriate supplemental forms (with attachments and exhibits, if necessary). These forms, DOT F3902.1 and supplements, will be supplied to the contractors by the project engineer. All reports shall be reviewed by the appropriate levels of management, who shall direct or recommend corrective action based on causative factors. The original copy of the accident investigation report shall be forwarded through channels to the FHWA Occupational Safety Staff for final action within 5 working days.

8. CHARGEABILITY OF ACCIDENTS. With one exception, the organization unit charged with the manhours for an employee will also be charged with the accident injuries associated with those manhours. The exception is that those accidental injuries which occur to trainees who are assigned to State highway agencies during their training periods will be charged to the Office of Personnel and Training in the Washington Headquarters.

9. TORT CLAIMS. Whenever there is a claim for personal injury or property damage due to an FHWA accident, the supervisor of the employee involved will investigate the accident and complete the required reports necessary for legal review. In the Washington Headquarters Office, the report will be forwarded to the Office of the Chief Counsel, HCC-50, and in the Regions to the Regional Counsel. After the legal review to determine liability and the cost of claim settlement has been determined by the legal counsel and the parties concerned, the tort claim will be sent to the appropriate official as listed in FHWA Order 1-1, Chapter 4, paragraph34, Tort Claims, for approval. Once approved, the claim will be settled by the Certifying Officer and Legal Counsel.

10. FORMS

    1. Forms required by this Order are:

       (1) DOT F3902.1, Accident Report.

       (2) DOT F3902.2 (Revised 7-73), Injury Report, Supplement 1.

       (3) DOT F3902.3, Motor Vehicle Report, Supplement M.

       (4) DOT F3902.4, Property Damage Report, Supplement P.

       (5) DOT F3902.5, Fire or Explosion Report, Supplement F.

       (6) OSHA Form 100F, Log of Federal Occupational Injuries and Illnesses.

       (7) OSHA Form 102F/102FF, Federal Occupational Injuries and Illnesses Survey.

       (8) GSA Standard Form 91.

       (9) GSA Standard Form 94.

    2. All of the above are available from the General Services Administration (GSA) Retail Stores except OSHA Form 102F and 102FF which is available from various OSHA area offices or printing review points (TAD-12 in OST).

    3. The instructions for coding accident information on DOT accident report supplements are found in the Safety Management Information System User's Manual supplied to each Regional Safety Manager.

/s/
William M. Cox
Federal Highway Administrator