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Workplace Inspections, and Injury, Illness and Motor Vehicle Incident Reporting

FSIS directive 4791.13
Series Type 4000 Series: Personnel
Issue Date Jun 19, 1996
Full Directive
4791.13.pdf

I. PURPOSE

This directive:

A. Describes the basic provisions for workplace inspections and reporting and recordkeeping requirements under the Agency's Occupational Safety and Health Program.

B. Provides injury, illness, and motor vehicle incident reporting and recordkeeping guidelines.

II. CANCELLATION

A. This directive cancels the information and guidelines on workplace inspections, injury, illness, and motor vehicle incident reporting previously contained in FSIS Directive 4791.1.

B. FSIS Directive 4791.1 is being revised to update the basic provisions and guidelines for the Agency's Occupational Safety and Health Program and to delete the portions canceled by this directive.

III. REASON FOR ISSUANCE

This directive provides:

A. Revised instructions for safety and health inspections including the use of checklists.

B. Instructions on injury/illness logs and the reporting of motor vehicle incidents.

IV. REFERENCES

  • FSIS Directive 2450.1, Use of Motor Vehicles for. Official Travel
  • FSIS Directive 3720.1, Federal Tort Claims
  • FSIS Directive 4791.1, Basic Occupational Safety and Health Program
  • FSIS Directive 4791.12, Reporting and Correcting Occupational Hazards
  • FSIS Directive 4810.1, injury Compensation
  • 29 CFR 1960, Basic Program Elements for Federal Employee Occupational Safety and Health Programs
  • Executive Order 12 96, Occupational Safety and Health Programs for Federal Employees
  • OSHA Booklet 2014, Recordkeeping and Reporting Guidelines for Federal Agencies
  • OSHA Booklet 2098, OSHA Inspections
  • OSHA Field Operations Manual, Federal Agency Programs
  • Public Law 91-596, Occupational Safety and Health Act of 1970
  • Laboratory Safety, Health, and Environmental Handbook

V. FORMS AND ABBREVIATIONS

The following will be used in their shortened forms:

  • ATAR Agency Technical Assistance Request
  • CSHO Compliance Safety and Health Officer
  • DASHO Designated Agency Safety and Health Official
  • FECA Federal Employees' Compensation Act
  • OSH Occupational Safety and Health
  • OSHA Occupational Safety and Health Administration
  • OWCP Office of Workers' Compensation Program
  • PD Personnel Division
  • PESB Program Evaluation and Safety Branch, PD
  • SHMD Safety and Health Management Division, USDA
  • WSHO Workplace Safety and Health Official
  • WSPO Washington Servicing Personnel Office, PD
  • FSIS Form 4791-17, Log of Federal Occupational Injuries and Illnesses
  • FSIS Form 4791-22, Notice of Unsafe or Unhealthful Working Condition(s)
  • FSIS Form 4791-23, Safety and Health Inspection Checklist, Office Facilities
  • FSIS Form 4791-24, Safety and Health Inspection Checklist, Plant Facilities
  • Form AD-112, Report of Unserviceable, Lost, or Damaged Property
  • Form AD-1010 poster), Occupational Safety and Health protection for USDA Employees
  • Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
  • Form CA-2, Notice of Occupational Disease and Claim for Compensation
  • Form CA-6, Report of Fatality
  • Form CA-16, Authorization for Examination and/or Treatment
  • Form SF-91, Motor Vehicle Accident Report
  • Form SF-94, Statement of Witness

VI. POLICY

It is Agency policy that:

A. All workplaces be inspected for OSH hazards at least annually. More frequent inspections are conducted in workplaces where there is more risk of injury or illness. This will be based on analyses of the workplace inspection reports and the number of reported hazards, and workplace injuries and illnesses which occur at the work location.

B. OSH inspections be conducted when employees report hazardous conditions or serious accidents.

C. OSHA standards be used as the minimum acceptable standards for inspections.

VII. DEFINITIONS

A. Catastrophe. An accident resulting in hospitalization for three or more people and at least one of them is an FSIS employee.

B. Controvert. To dispute, challenge, or deny the validity of a claim for continuation of pay. Also used to apply to the validity of a claim.

C. Fatality. A death resulting from an occupational traumatic injury, illness, or disease.

D. Injury. A wound or other condition of the body caused by external force, stress or strain. The injury is identifiable as to time and place of occurrence and member or function of the body affected, and is caused by a specific event or incident or series of events or incidents within a single day or work shift.

E. Lost Time Case. A nonfatal injury causing loss of time from work beyond the day or shift in which it occurs, or a nonfatal occupational illness causing loss of time from work or disability at any time. Incidents resulting in permanent transfer, termination of employment, or subsequent granting of continuation of pay are considered lost time cases.

F. No Lost Time Case. A nonfatal incident not meeting the definition of lost time case (Example: a first aid incident). This usually results in a claim for medical expenses.

G. Occupational Illness or Disease. A condition produced in the work environment over a period longer than one workday or shift. It may result from systemic infection, repeated stress or strain, exposure to toxins, poisons, fumes or other continuing conditions of the work environment. For practical purposes, an occupational illness or disease is any reported condition that does not meet the definition of injury.

H. Safety and Health Inspector. A person with the necessary equipment and competence to recognize safety and health hazards in the workplace.

PART TWO--SAFETY AND HEALTH WORKPLACE INSPECTIONS

I. AGENCY SAFETY AND HEALTH INSPECTIONS

Safety and health inspections are conducted by the official-in-charge or the supervisor of the workplace, by an employee designated by the official-in-charge or supervisor, by the WSHO, and by other Agency personnel. A Union representative, preferably a member of a safety and heath committee, shall accompany the safety and health inspector during the inspection of an installation within the unit.

A. Conduct of Agency Workplace Inspections. Safety and health inspectors shall:

  1. Review all pertinent background information including injury and illness logs, previous inspection reports, and reports of unsafe and unhealthy working conditions before beginning the inspection.
  2. Comply with all OSH rules and practices.
  3. Wear and use protective clothing and equipment.
  4. Conduct inspections and investigations in a manner that does not unreasonably disrupt operations.
  5. Consult with Agency employees, as needed, to make a thorough and effective inspection or investigation.
  6. Provide the official-in-charge and recognized employee representative the opportunity to provide information about hazardous conditions.
  7. Confer with the appropriate official-in-charge and recognized employee representative when the inspection or investigation is completed.
  8. Complete the safety and health inspection checklist (see Attachment 2-1, Attachment 2-2, or the Laboratory Safety, Health, and Environmental Handbook) and other written reports as required to document inspection findings. Forward the checklist and reports to the appropriate supervisory official for review and action.

B. Notice of Unsafe or Unhealthful Working Conditions. The official-in-charge or the supervisory official:

  1. Issues FSIS Form 4791-22 when unsafe or unhealthy working conditions found during the inspection cannot be corrected at the time of the inspection. The Notice shall be issued not later than 30 days after completion of the inspection.
  2. Posts the Notice form for 3 working days or until the unsafe or unhealthy condition is corrected, whichever is later.
  3. Prepares a written abatement action plan for corrections that will require 30 or more calendar days. See FSIS Directive 4791.12 which contains procedures for reporting and correcting occupational hazards.

II. OSHA INSPECTION, EVALUATION, AND ASSISTANCE

The Agency, is required to provide a safe and healthful workplace that is free from recognized hazards for its employees working in Government owned or leased space and for its employees working in private-sector workplaces. However, the abatement of many hazards identified by the Agency or by OSHA in private-sector workplaces such as meat, poultry, and egg products plants will require corrective action by the plant owner.

A. Inspection. OSHA CSHO's conduct announced and unannounced inspections of Agency workplaces for the following reasons:

  1. A targeted inspection is programmed and conducted on the basis of objective criteria and is based on the lost-time compensation claims rate.
  2. A fatality/castastrophe investigation is conducted when an incident results in a fatality or in the in-patient hospitalization of three or more persons and at least one of those persons is an FSIS employee.
  3. A complaint investigation is conducted when an employee reports unsafe or unhealthful working conditions. OSHA may respond to the complaint by:
  • a. Requesting the Agency to investigate the complaint. OSHA sends the request by letter to the supervisor or official-in-charge. The supervisor or official-in-charge immediately forwards the OSHA letter through channels to PESB and conducts an investigation. PESB coordinates all responses from the DASHO to OSHA.
  • b. Conducting an inspection. (See Subparagraph E.)

B. Evaluation. OSHA analyzes injury and illness reports, and conducts onsite field reviews and special studies to evaluate the effectiveness of Agency safety and health programs.

C. ATAR's. OSHA responds to ATAR's for onsite assistance such as hazard abatement advice, training, partial or comprehensive inspections, and program assistance.

D. Cooperation. Title 29 CFR 1960 authorizes OSHA representatives "to enter without delay, and at reasonable times, any building, installation, facility, construction site, or any other area, workplace, or environment where work is performed by employees of the Agency; to inspect and investigate during regular hours and at other reasonable times, and within reasonable limits and in a reasonable manner, any such place of employment, and all permanent conditions, structures, machines, apparatus, devices, equipment, and materials therein; and to question privately any employee any supervisory employee, and/or any official in charge of an establishment.” OSHA does not need a warrant or subpoena to inspect a Federal workplace. FSIS employees should be familiar with this authorization to avoid misunderstandings between FSIS and OSHA.

E. Conduct of Inspections. OSHA inspections of Agency workplaces are conducted as follows:

  1. The CSHO presents his or her credentials to the supervisor or official-in-charge upon entering the workplace.
  2. The CSHO conducts an opening conference with the supervisor or official-in-charge and an employee representative who is selected according to the Collective Bargaining Agreement. The CSHO gives the reason for, and the scope of, the inspection.
  3. The CSHO conducts the inspection which may include a records review. The supervisor or official-in-charge and the employee representative accompany the CSHO during inspection.
  4. The supervisor or official-in-charge and other Agency employees shall provide any information available at the workplace that the CSHO requests concerning safety and health conditions and programs. This includes information about air contaminants, injury and illness logs, reports of unsafe or unhealthy working conditions, personal protective equipment, the hazard communication program, the hearing conservation program, and the lockout/tagout program. Agency employees may be requested to wear monitoring devices. If information is not available at the workplace, the supervisor or official-in-charge requests assistance through channels from the WSHO. (Names, locations, and telephone numbers of WSHO's are listed on Form AD-1010, displayed in all Agency workplaces.)
  5. The CSHO conducts a closing conference with the supervisor or official-in-charge and employee representative. The CSHO describes apparent violations found during the inspection.
  6. The supervisor or official-in-charge notifies the WSHO through channels of any OSHA inspections and any violations found during OSHA inspections. Corrective action should be initiated before OSHA issues the Notice of Unsafe or Unhealthful Working Conditions. All Notices issued to the supervisor or official-in-charge from OSHA are immediately forwarded through channels to PESB. PESB coordinates all responses from the DASHO to OSHA. Notices must be posted at the workplace for 3 working days or until the violation is abated, whichever is longer.
  7. OSHA may conduct follow-up inspections to determine if violations have been corrected or when an Agency's investigation report is unsatisfactory.

PART THREE--INJURY, ILLNESS, AND MOTOR VEHICLE INCIDENT REPORTING AND RECORDKEEPING GUIDELINES

I. INTRODUCTION

The FECA provides compensation benefits to employees who sustain injury or disease while in the performance of duty. See FSIS Directive 4810.1 for FECA benefits and claim filing instructions.

A. The OSHA requires that Federal Agencies collect occupational injury and illness data to analyze and identify unsafe and unhealthy working conditions. Agencies establish program priorities based on these analyses.

B. The OSHA uses injury and illness data from FECA compensation forms to set program priorities, identify Federal worksites for OSHA inspections, monitor progress to reduce occupational injuries, illnesses, and fatalities, and to report on the status of occupational civilian employee safety and health.

C. Federal Agencies shall:

  1. Maintain a Log of Occupational Injuries and Illnesses.
  2. Code OSHA-related items on OWCP forms.
  3. Use only Forms CA-1, CA-2, and CA-6 dated 1986 or later to report occupational injuries and illnesses.

II. LOG OF OCCUPATIONAL INJURIES AND ILLNESSES

The WSPO maintains FSIS Form 4791-17 for all Forms CA-1, CA-2, and CA-6 filed through WSPO. The supervisor at each establishment maintains the log form (see Attachment 3-1 to provide a quick and current view of workplace safety and health. The WSPO or supervisor maintains the log as follows:

A. Completes the log within 6 workdays after receiving information on an incident.

B. Logs injuries, illnesses, and fatalities for each Form CA-1, CA-2, or CA-6 filed with the OWCP. (NOTE: Do not log Forms CA-1 and CA-2 for incidents where no lost time or medical reimbursement is required. Do forward these forms through supervisory channels to the applicable Servicing Personnel Office for placement in the employee's medical folder.)

C. Logs controverted or otherwise challenged claims. These may be lined out if OWCP denies legitimacy.

D. Uses FSIS Form 4791-17 to post yearly totals of all injuries, illnesses, and fatalities on the Government bulletin board in each establishment. This is posted within 45 days of the close of the fiscal year and remains posted for 30 consecutive days.

III. RECORDS AND RECORDS RETENTION

A. Records. An incident resulting in a fatality, lost time, or medical expense including termination and permanent transfer, warrants investigation and analysis. The supervisor documents the incident information on the OWCP Forms CA-1, CA-2, and CA-6, as required.

  1. Identify the personnel, equipment and activities involved, and the causes and contributing factors.
  2. Maintain copies of the completed OWCP forms in the Agency offices that process OWCP forms (Examples: Personnel Operations Branch, PD, and WSPO) Privacy Act restrictions apply for OWCP forms and accident prevention data used.

B. Retention. Retain logs, records, and reports for 5 years following the end of the fiscal year to which they relate.

IV. COMPLETING AND CODING FORMS CA-1, CA-2, AND CA-6

OSHA requires that agencies complete information and code applicable items on Forms CA-1, CA-2, and CA-6 before submitting them to the OWCP. This information allows the Agency to evaluate and improve safety and health programs. Complete and code the forms as follows:

A. Employee. Completes items according to the instructions on Form CA-1 or Form CA-2. Inspection personnel also enter the establishment number, if applicable, and the address of the location where the injury occurred or where the illness first occurred. This is Block 9 on Form CA-1 and Block 10 on Form CA-2.

B. Supervisor. Completes items according to the instructions on Form CA-1 or Form CA-2 and enters the following codes:

  1. Occupation Code. Identify the occupation by entering the two letters of the employee's pay plan and the four numbers of the occupation series. (EXAMPLES: GS1863 and GS0701).
  2. Type and Source of Injury Codes. These codes are used to describe how the incident occurred (see Attachment 3-2). Select the most specific type and source codes to describe the event that initiated the injury or illness. Avoid the use of "type code 999" or "source code 9999." If there is insufficient information, or if the available codes do not exactly describe the type or source, use a "heading" code instead. Where there are two different sources, code the initiating source of the incident (see Example 1). Following are examples of correct type and source coding:
  • a. Example 1: An inspector tripped on the wet floor and struck his or her head on a gut buggy. NOTE: This example is not coded 120 (struck against) and 0500 (material handling equipment).
  1. Type: 210 Fell On Same Level
  2. Source: 0110 Walking/Working Surface
  • b. Example 2: An inspector was kicked by a cow.
  1. Type: 110 Struck By
  2. Source: 0910 Animal
  • c. Example 3: An inspector contracted psittacosis while inspecting turkeys.
  1. Type: 520 Contacted By
  2. Source: 0913 Disease
  • d. Example 4: An inspector cut his or her left thumb with a knife.
  1. Type: 420 Cut By +
  2. Source: 0320 Hand Tool (Non-Powered)
  • e. Example 5: An employee was driving a Government vehicle when it was struck by another vehicle.
  1. Type: 800 Traveling In. NOTE: The type code 800 is different from other type codes. It is used to collect data on the type of vehicle the employee operated or traveled in at the time of the incident rather than to identify factors contributing to an injury or fatality.
  2. Source: 0421 Government-Owned, As Driver
  3. Zip Code. Enter the zip code of the duty station where the employee worked when the injury or illness occurred.
  4. OWCP Agency Code. Enter 8324 for Inspection Operations employees. Enter 8339 for all other FSIS employees.
  5. OSHA Site Code. Leave Blank.

V. MOTOR VEHICLE ACCIDENTS AND PROPERTY DAMAGE INCIDENT REPORTING

A. Motor Vehicle Accidents. These are all incidents that involve the operation of a Government owned or leased or privately owned motor vehicle used for official business. This includes incidents that result in damage to parked, official-use vehicles and incidents that result solely from natural causes with no human intervention (Examples: earthquake, flood).

B. Incident Reporting. Motor vehicle accidents and property damage incidents involving motor vehicles are reported by the driver to his or her supervisor. If police investigate the accident, the driver obtains a copy of the police report. In some jurisdictions, the driver must also file a report with the Motor Vehicle Department. Complete forms to report incidents as follows:

1. Driver.

  • a. Completes Form SF-91, Sections I through IX.
  • b. Completes Form SF-94.
  • c. Completes Form AD-112 only when there is damage to Government owned or leased vehicle (see FSIS Directive 2450.1).
  • d. Completes Form CA-1, if injured.
  • e. Notifies the GSA Fleet Management Center as soon as possible, if the vehicle involved is a GSA-leased vehicle.
  • f. Submits forms and the police report, if applicable, to the supervisor.

2. Supervisor.

  • a. Completes Form SF-91, Section X, Items 72 through 82c.
  • b. Reviews and completes Form AD-112, when required.
  • c. Completes the Supervisor's portion of Form CA-1, if the employee is injured. Completes and issues Form CA-16, if the employee requires medical care.
  • d. Notifies the WSHO immediately if an Agency employee is killed in a motor vehicle accident.
  • e. Submits a clear and legible copy of Form SF-91"to the GSA Fleet Management Center. Sends the original copies of Forms SF-91 and AD-112 through supervisory channels to the Procurement and Property Branch, Administrative Services Division, Washington, DC.

3. WSH0. If an Agency employee is killed in a motor vehicle accident, the WSHO investigates the accident and completes Form SF-91, Section XI, Items 83 and 84, and Section XIII, Item 87. A third party who is injured or suffered property damage as the result of a motor vehicle incident may wish to file a claim against the Federal Government. (See FSIS Directive 3720.1.)

VI. SERIOUS INCIDENT REPORTING

A. A serious incident is an incident resulting in:

  1. A job-related fatality.
  2. Hospitalization of three or more persons and at least one of them is an FSIS employee.
  3. Property damage over $100,000.
  4. A handicapping injury.

B. A serious incident is reported even when there is some doubt that it is job-related.

C. The supervisor must report fatalities and catastrophes to the local OSHA office or to the OSHA Hotline at 1-800-321-OSHA.

D. The supervisor or another Agency official must report serious incidents immediately to the Chief, PESB, by telephone, HPDesk message, or facsimile. Provide the following information:

  1. Type of incident.
  2. Date and time of incident.
  3. Organizational unit.
  4. City and State where the incident occurred.
  5. Name, age, grade, occupational series, and Social Security Number of the person involved.
  6. Name and telephone number of local Agency contact.
  7. Name and telephone number of local OSHA contact.
  8. Description of nature and extent of injury, illness, or property damage.
  9. Suspected causes and preliminary actions taken.
  10. Name and telephone number of the person preparing the report.

E. PESB reports serious incidents to the SHMD. The Agency must report a serious incident within 8 hours. The SHMD notifies the OSHA headquarters officials at the Department of Labor, as appropriate.

See full PDF for Attachments 

  • Sample FSIS Forms 4391-23 Safety and Health Inspection Checklist- Office Facilities 
  • Sample FSIS Forms 4791-24 Safety and Health Inspection Checklist- Plant Facilities 
  • Sample FSIS Forms 4791-17 Log of Federal Occupational Injuries and Illnesses  
  • Type and Source Codes