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This type of report should be written for every accident even if no injuries occur. It does not take the place of an official accident report of injury to a student. Its best use is as a data gathering device for accident prevention initiatives. School boards should have their own policy on student accident/injury reports (these reports are to be determined by teachers in collaboration with administrators).
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Checklist:
These headings are the minimum suggested for inclusion in a contract. Your school division policy may include other requirements. |
Indicate probable causes or factors such as:
Recommendations for each type of hazard may be found in Chapter 7 Procedures of this manual Also refer to each chemical's MSDS |
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Accident Investigation Report
Date of report: September 23, 1996
Report submitted to: A. Principal
Time/Date of event: 2:15 p.m. September 22, 1996
Place: Room 123 (Chem Lab)
Type of accident: Hot solution spill
Injury sustained by: A. Kidd
Teacher in charge: A. Chemist
Report submitted by: _______________________________
Names of two witnesses: ____________________________
______________________________
Number of Students in Group: _______
Were other students or teachers injured at the same time? If so, attach a separate form for each individual injury.
Description of Accident: A student passing the lab bench caught the ring stand wing nut with a loose sleeve on his sweater. The entire stand, beaker, and its contents fell to the bench top. The beaker contained approximately 150 mL of a hot solution of sodium hydroxide (approximately 1.0 mol/L) which was being heated above a bunsen burner. When the solution spilled, A. Kidd was splashed from waist to knee on the left leg. The beaker did not break.
Result of Accident: A. Kidd's pants appear to be permanently stained. There was some heat and chemical damage to the skin on the student's thigh. Apparent extent of injury includes second-degree burns to a 10 cm by 20 cm area.
Action Taken: Students in the area were ordered away by the teacher. The main gas valve was turned off by a student on instruction from the teacher. At the same time, the teacher took the injured student to the side sink and used a shower spray attached to the faucet to flush the affected area for some time (approximately 15 minutes).
One student was sent to the office to report the accident and to ask administrators to arrange for transportation to the emergency ward. Another student was sent to get the help of the janitor in containing the considerable amount of water on the floor. The injured student was taken to emergency by the vice-principal. Clean-up involved neutralization of the sodium hydroxide with sodium carbonate.
Contributing factors include
Recommendations include