## 1. Key Details

click to collapse/expand
BEFORE completing Incident Reports, you should take THIS training course (https://youtu.be/Wr7sI0qGoJI) . Edit your incident reports on mobile as follows: In-progress reports are located in the Compliance app's "To-Do List". Access and edit/update submitted reports with Safari or Chrome from the event list (refer to training (https://www.youtube.com/watch?v=m1fYqDHezCM) , but via phone instead of computer when it comes to opening events at the 5:40 mark).
1. Primary InvolvedList Radio
Select the party that contributed most/first to the accident. If subcontractor, select "Trade Contractor".
Member of the Public Sundt Advanced Facilities Sundt Building Sundt Companies - Use this option for Sundt personnel whom are not assigned to a division/operating group. Sundt Concrete Sundt Equipment Services Sundt Heavy Industrial and Mining Sundt Industrial Sundt Renewables Sundt Transportation Sundt Water and Wastewater Third Party Trade Contractor Warehouse (Sundt)
2. Trade Contractor responsible for operationIntegrated list
3. Write in: If not listed, indicate the trade contractor responsible for the operation.Text Short
4. Primary Incident TypeList Radio
Select the Incident Type based off of the sequence of events.
Auto/Motor Vehicle Chemical Spill Construction Equipment (non motor vehicle) Crane Injury - Work-related injuries https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.5 (https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.5) Inspection by Regulatory Agency Near Miss - If no damage or injury occurred, but something physically happened that was unfavorable, the incident is considered a Near Miss. Personal Medical Issue - NON work-related injury/illness Property Damage (not utility related) Sundt Driver Complaint Theft Utility Damage - Above/at/underground utility struck/grazed/damaged Water Intrusion
5. Second Incident TypeList Radio
None - N/A Auto/Motor Vehicle Chemical Spill Construction Equipment (non motor vehicle) Crane Inspection by Regulatory Agency Near Miss - If no damage or injury occurred, but something physically happened that was unfavorable, the incident is considered a Near Miss. Property Damage (not utility related) Sundt Driver Complaint Theft Utility Damage - Above/at/underground utility struck/grazed/damaged Water Intrusion
6. Third Incident TypeList Radio
None - N/A Auto/Motor Vehicle Chemical Spill Construction Equipment (non motor vehicle) Crane Inspection by Regulatory Agency Near Miss - If no damage or injury occurred, but something physically happened that was unfavorable, the incident is considered a Near Miss. Property Damage (not utility related) Sundt Driver Complaint Theft Utility Damage - Above/at/underground utility struck/grazed/damaged Water Intrusion
7. Fourth Incident TypeList Radio
None - N/A Auto/Motor Vehicle Chemical Spill Construction Equipment (non motor vehicle) Crane Inspection by Regulatory Agency Near Miss - If no damage or injury occurred, but something physically happened that was unfavorable, the incident is considered a Near Miss. Property Damage (not utility related) Sundt Driver Complaint Theft Utility Damage - Above/at/underground utility struck/grazed/damaged Water Intrusion
8. Incident CategoryList Radio
Work Related Not work related / not associated with project activity / For report only - Use this for incidents that occurred on personal time. Driving on a public roadway
9. Purpose of travelList Radio
Company business Not business related Commuting to/from work
10. Division of Work (scope being performed when incident occurred)List Drop-down
What was the scope/division of work that caused/contributed to the incident? If a worker fell off a ladder while installing sheet metal flashing on a roof parapet, the appropriate division would be 05 Metals
11. Was the incident STCKY?List Radio
Released STCKY energy contacted or came within six feet of personnel (or could have)
Yes No
12. What primary STCKY Energy contributed to the incident?List Radio
S#!t That's Built at Heights S#!t That's Built in Confined Spaces S#!t That's Built Underground S#!t That's Energized S#!t That's Hazardous S#!t That Lifts S#!t That Moves or Crushes S#!t That Stores Energy
13. Date and Time Incident OCCURREDDate time
14. Incident reported:List Radio
(reported to Sundt project management)
Promptly reported - prompt = within a short, reasonable amount of time Delayed report - delayed = more than half a work day since incident occurred
15. Reason for delay in reporting:List Radio
Involved party delayed report to supervision Supervision delayed report to Sundt project management Other
16. Date and Time Incident REPORTEDDate time
17. Reason for delay in reportingText Short
18. Work ActivityList Radio
Scheduled Unscheduled - not planned, no lookaheads, etc.
19. Work TypeList Radio
Initial work - first time scope performed/attempted Ongoing Work - continuing operation of defined scope Rework - fixing work already placed Out-of-scope work - work that falls outside the initially defined scope of work
20. Activity ExecutionList Radio
As planned per THA Deviation from THA No THA THA not required
21. Time TypeList Radio
Regular Time / Working hours Over Time Non working hours
22. How many people were affected by or involved in this incident? - Not bystanders or witnessesList Radio
0 1 2+ TBD / Answer Pending
23. How many different vehicles, pieces of equipment, or major pieces of property were damaged/stolen/involved?List Radio
Not including cranes or utilities
0 1 2 3+ TBD / Answer Pending
24. How many different cranes were involved?List Radio
1 2+ TBD / Answer Pending
25. How many different utilities were damaged?List Radio
Not including cranes or utilities
0 1 2+ TBD / Answer Pending
26. How much chemical was spilled?List Radio
Minor - more than incidental use Major - government reporting required TBD / Answer Pending
27. What chemical was spilled?Text Short
28. WHERE incident occurredText Short
(NOT project)
29. Incident DescriptionText Long
Describe how the incident occurred. Use this GPT for assistance. (https://chatgpt.com/g/g-nT7yZSd9i-ida) Ensure that for injuries, include where treatment was provided (on site, clinic, etc) and what the current work status is (returned to work to tolerance, placed on restricted duty, etc). DO NOT: make statements about how the incident could have been avoided retaliate against injured/affected persons repeat content already inputted thus far like date, time, location, etc.

## 2. Involved Party #1

click to collapse/expand
30. Party TypeList Radio
Sundt Trade Contractor Third Party Other
31. Trade Contractor CompanyIntegrated list
32. Trade Contractor Employee NameText Short
33. Party's NameText Short
34. Sundt Employee NamePeople
35. Write in if not listed: Sundt Employee NameText Short
36. Phone NumberText
37. Shift Start TimeTime
38. Shift End TimeTime
39. Last Day Off from WorkDate
40. Was the THA reviewed in a language and manner the party proficiently understood?List Radio
Yes No Unknown / TBD / N/A - or not applicable
41. Time with employer?List Radio
Less than thirty days Less than one year More than one year Unknown or TBD
42. Time on project?List Radio
Less than one week Less than 90 days More than 90 days Unknown or TBD
43. Was person working out of town / traveling?List Radio
Yes No Unknown or TBD
44. Commute LengthList Radio
under 30 minutes 30 minutes - 1 hour 1-2 hours over 2 hours Unknown or TBD
45. Was required PPE worn?List Radio
Yes No N/A, Unknown or TBD
46. What required PPE was missing?List Checkbox
Fall protection Glasses Gloves Goggles / Face Shield Hard Hat Hard hat chin strap Hearing Protection High Visibility Clothing Respirator Safety Shoes Seatbelt Other Unknown or TBD
47. Other PPE NOT worn:Text Short
48. Job RoleList Drop-down
49. Who was their supervisor at the time of incident?People
50. Write in if not listed: Who was their supervisor at the time of incident?Text Short
51. Was Party #1 injured?List Radio
No injury Yes, injury occurred
52. Reminder: If Sundt employee's injury is NOT life threatening, Occucare must be called ASAP: 866-268-0884Text Label

## 3. Involved Party #1: Injury Details

click to collapse/expand
Input the more seriously injured party first (if multiple injured)
53. How many major/separate injuries does Party #1 have?List Radio
1 2 3
54. Body Part Injured (#1)List Multi-level
Input the most severe injury first
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
55. Injury Type (#1)List Drop-down
56. Main Cause of Injury (#1)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to electricity Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
57. Body Part Injured (#2)List Multi-level
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Other multiple body parts Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
58. Injury Type (#2)List Drop-down
59. Main Cause of Injury (#2)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to electricity Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
60. Body Part Injured (#3)List Multi-level
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Other multiple body parts Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
61. Injury Type (#3)List Drop-down
62. Main Cause of Injury (#3)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to electricity Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
63. Treatment ClassificationList Radio
Jobsite Treatment Offsite Medical Treatment Treatment declined by injured party
64. Medical Treatment ProviderList Radio
REMEMBER TO CALL OCCUCARE FIRST FOR NON EMERGENCY INJURIES INVOLVING SUNDT PERSONNEL 866-268-0884
Occupational Health Clinic Hospital / Emergency Room / EMS (911) After Hours / Urgent Care
65. First Aid ProviderList Radio
Occucare Jobsite First Aid Provider (i.e. Project Site Nurse, etc.) Project personnel Self administered
66. Treatment OutcomeList Radio
STCKY Injury - Select SIF criteria from the box below.
First Aid Restricted Duty Days Away from work / Lost Time Other Recordable Criteria - Other Recordable Criteria = prescriptions, therapy, etc., Anything other than Restricted Duty or Lost Time STCKY Injury - STCKY Injury - Life Threatening (LT) - Worker would not survive without medical intervention
67. STCKY Injury - SIF CriteriaList Radio
Fatality Amputations (involving bone) excludes distal phalanx Head trauma that results in a traumatic brain injury (TBI) Injury or trauma to vital organs Bone fractures requiring surgery for repair, excluding fingers and toes Acute traumatic herniated disc with neurologic deficit 3rd degree burn requiring skin graft Eye injuries resulting in permanent vision loss or change in vision High pressure injection injuries requiring surgical debridement and irrigation Heat Stroke – Medically diagnosed Electrical Contact Injury – Resulting in life-threatening cardiac, neurological, or burn injuries requiring emergency or hospital-level care Vascular trauma requiring surgery Acute chemical or radiological exposure resulting in injury to vital organs Other Injuries
68. Injury Classification: First AidText Label
69. Injury Classification: RecordableText Label
70. Does this injury require reporting per "1904 Subpart E - Reporting Fatality, Injury and Illness Information to the Government"?Choice
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours. https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.39 (https://www.osha.gov/laws-regs/regulations/standardnumber/1904/1904.39)
Yes No
71. Clinic Hospital NameText Short
72. Clinic Hospital AddressText Short
73. Clinic Hospital Phone NumberText Short
74. First day of lost timeDate
75. Has lost time ended?List Radio
Yes, returned to regular duty Yes, returned to modified duty Yes, employee was terminated No, employee is currently on lost time
76. First day of modified dutyDate
77. Date returned to modified dutyDate
78. Date returned to regular workDate
79. Employment Termination DateDate
80. Miscellaneous Injury Notes / Other Recordable Criteria:Text Short
81. Employee NumberText Short
Input a single 0 if employee number cannot be obtained
82. Date of BirthDate
Input date of 1/1/1911 if unknown
83. Date of HireDate
84. Current, Physical Address (Street name & number, city, state, zip)Text Short
85. Hourly WageNumber
Input 1 if unknown
86. Side of Body InjuredList Radio
Right Left Both
87. GenderList Radio
Male Female
88. Name of physician or healthcare professionalText Short
89. Was employee hospitalized overnight as an in-patient?List Radio
Yes No
90. What was the employee doing just before the incident occurred?Text Short
91. If the employee died, when did death occur?Date time

## 4. Involved Party #2

click to collapse/expand
92. Party TypeList Radio
Sundt Trade Contractor Third Party Other
93. Trade Contractor CompanyIntegrated list
94. Trade Contractor Employee NameText Short
95. Party's NameText Short
96. Sundt Employee NamePeople
97. Write in if not listed: Sundt Employee NameText Short
98. Phone NumberText
99. Shift Start TimeTime
100. Shift End TimeTime
101. Last Day Off from WorkDate
102. Was the THA reviewed in a language and manner the party proficiently understood?List Radio
Yes No Unknown or TBD - or Not Applicable
103. Time with employer?List Radio
Less than thirty days Less than one year More than one year Unknown or TBD
104. Time on project?List Radio
Less than one week Less than 90 days More than 90 days Unknown or TBD
105. Was person on subsistence?List Radio
Yes No Unknown or TBD
106. Commute LengthList Radio
under 30 minutes 30 minutes - 1 hour 1-2 hours over 2 hours Unknown or TBD
107. Was required PPE worn?List Radio
Yes No N/A, Unknown, or TBD
108. What required PPE was missing?List Checkbox
Fall protection Glasses Gloves Goggles / Face Shield Hard Hat Hard hat chin strap Hearing Protection High Visibility Clothing Respirator Safety Shoes Seatbelt Other Unknown or TBD
109. Other PPE NOT worn:Text Short
110. Job RoleList Drop-down
111. Who was their supervisor at the time of incident?People
112. Write in if not listed: Who was their supervisor at the time of incident?Text Short
113. Was Party #2 injured?List Radio
No injury Yes, injury occurred
114. Reminder: If Sundt employee's injury is NOT life threatening, Occucare must be called ASAP: 866-268-0884Text Label

## 5. Involved Party #2: Injury Details

click to collapse/expand
115. How many major/separate injuries does Party #2 have?List Radio
1 2 3
116. Body Part Injured (#1)List Multi-level
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
117. Injury Type (#1)List Drop-down
118. Main Cause of Injury (#1)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
119. Body Part Injured (#2)List Multi-level
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Other multiple body parts Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
120. Injury Type (#2)List Drop-down
121. Main Cause of Injury (#2)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
122. Body Part Injured (#3)List Multi-level
Head Head, unspecified Cranial region, including skull Brain Scalp Skull Multiple cranial region locations Ear(s) Face Forehead Eye(s) Nose, nasal cavity Nose, except internal location of diseases or disorders Nasopharynx Nasal passage(s) Sinus(es) Multiple internal nasal locations Cheek(s) Jaw, chin Mouth Lip(s) Tongue Tooth (teeth) Gum Multiple mouth locations Multiple face locations Multiple head locations Neck, Including Throat Neck, except internal location of diseases or disorders Vocal cord(s) Larynx Laryngopharynx Pharynx Trachea Multiple internal neck locations Trunk Chest, including ribs, internal organs Chest, except internal location of diseases or disorders Esophagus Heart Bronchus Lung(s), pleura Breast(s)—internal Multiple internal chest locations Back, including spine, spinal cord Thoracic region Lumbar region Sacral region Coccygeal region Multiple back regions Back, including spine, spinal cord, n.e.c. Abdomen Abdomen, except internal location of diseases or disorders Stomach organ Spleen Urinary organs Bladder Kidney(s) Multiple urinary organs Intestines, peritoneum Peritoneum Small intestine Large intestine, colon, rectum Multiple intestinal locations Other digestive structures Liver Gallbladder Pancreas Multiple other digestive structures Multiple internal abdominal locations Pelvic region Pelvic region, unspecified Hip(s) Pelvis Buttock(s) Groin External reproductive tract structures Scrotum Penis External female genital region Multiple external reproductive tract structures Internal reproductive tract structures Prostate Testis (testes) Ovary (ovaries) Uterus Multiple internal reproductive tract structures Multiple pelvic region locations Multiple trunk locations Upper Extremities Shoulder(s), including clavicle(s), scapula(e) Arm(s) Upper arm(s) Elbow(s) Forearm(s) Multiple arm locations Elbow(s) and arms(s) Wrist(s) Hand(s) Hand(s), except finger(s) Finger(s), fingernail(s) Fingernail(s), nailbed(s) Fingertip(s) Finger(s), fingernail(s), n.e.c. Hand(s) and finger(s) Hand(s), n.e.c. Multiple upper extremities locations Hand(s) and arms(s) Hand(s) and elbow(s) Hand(s) and wrist(s) Wrist(s) and arm(s) Wrist(s) and elbow(s) Shoulder(s) and arm(s) Lower Extremities Leg(s) Thigh(s) Knee(s) Lower leg(s) Multiple leg locations Knee(s) and leg(s) Ankle(s) Foot (feet) Top of Foot (feet) Sole(s) Sole(s), unspecified Ball(s) of the foot Arch(es), instep(s) Heel(s) Multiple sole locations Toes(s), toenail(s) Multiple foot (feet) locations Multiple lower extremities locations Foot (feet) and leg(s) Foot(feet) and knee(s) Foot (feet) and ankle(s) Ankle(s) and leg(s) Ankle(s) and knee(s) Body Systems Multiple Body Parts Head and neck Head, neck, and trunk Head and trunk Neck and back Shoulder(s) and back Hip(s) and leg(s) Upper and lower limb(s) Other multiple body parts Whole body Other Body Parts Prosthetic and orthopedic devices Prosthetic and orthopedic devices of the head Prosthetic and orthopedic devices of the trunk Prosthetic and orthopedic devices of the upper extremities Prosthetic and orthopedic devices of the lower extremities Prosthetic and orthopedic devices involving multiple body parts Nonclassifiable Respiratory System
123. Injury Type (#3)List Drop-down
124. Main Cause of Injury (#3)List Multi-level
Contact with Objects & Equipment Caught in Caught between rolling powered vehicle and other object Caught in or compressed by equipment or objects Caught in running equipment or machinery Caught in running equipment or machinery during maintenance, cleaning Caught in running equipment or machinery during regular operation Compressed or pinched between two stationary objects Compressed or pinched by shifting objects or equipment Engulfment in other collapsing material Entangled in other object or equipment Excavation or trenching cave-in Landslide Mine collapse or cave-in Other cave-in Contact Contact with objects and equipment Injured by handheld object or equipment Injured by object breaking in hand Injured by slipping or swinging object held by injured worker Injured by slipping or swinging object held by other person Rubbed or abraded by foreign matter in eye Rubbed or abraded by friction or pressure Rubbed or abraded by kneeling on surface Rubbed or abraded by objects being handled Rubbed or abraded by shoes, apparel, or accessories Rubbed, abraded, or jarred by other machine or equipment vibration Rubbed, abraded, or jarred by vehicle or mobile equipment vibration Rubbed, abraded, or jarred by vibration Stepped on object Struck against Struck against moving object or equipment Struck against moving part of machinery or equipment Struck against object or equipment Struck against object or equipment while moving it Struck against stationary object or equipment Struck against stationary object or equipment while rising Struck by Struck by discharged object or substance Struck by discharged or flying object Struck by dislodged flying object, particle Struck by falling object or equipment Struck by falling object or equipment - other than powered vehicle Struck by falling part of powered vehicle still attached Struck by object falling from vehicle or machinery - other than vehicle part Struck by object or equipment Struck by object or equipment dropped by injured worker Struck by object or equipment dropped by other person Struck by object or equipment rolling freely Struck by or caught in swinging door or gate Struck by other falling powered vehicle Struck by powered vehicle - nontransport Struck by powered vehicle tipping over - nontransport Struck by rolling object or equipment - other than powered vehicle Struck by rolling object or equipment - other than powered vehicle, unspecified Struck by rolling object or equipment being pushed by another person Struck by rolling object or equipment being pushed by injured worker Struck by swinging or slipping object, other than handheld Struck by swinging part of powered vehicle Struck by thrown object - unintentional injury Struck or run over by rolling powered vehicle Struck, caught, or crushed in collapsing structure, equipment, or material Struck, caught, or crushed in other collapsing structure or equipment Exposure to Harmful Substances or Environments Choking on object or substance Contact with cold objects or substances Contact with hot objects or substances Depletion of oxygen Direct exposure to electricity Direct exposure to electricity, 220 volts or less Direct exposure to electricity, greater than 220 volts Exposure through intact skin, eyes, or other exposed tissue Exposure through medical injection Exposure through scratch or other open wound Exposure through unintentional needlestick or sharp injury Exposure to air and water pressure change Exposure to change in air pressure Exposure to change in water pressure Exposure to electricity Exposure to environmental cold Exposure to environmental heat Exposure to harmful substance through skin, eyes, or other exposed tissue Exposure to light Exposure to light and other radiation Exposure to noise Exposure to other harmful substance - multiple routes of exposure Exposure to other harmful substances Exposure to other radiation Exposure to oxygen deficiency, unspecified Exposure to radiation and noise Exposure to temperature extremes Indirect exposure to electricity Indirect exposure to electricity, 220 volts or less Indirect exposure to electricity, greater than 220 volts Ingestion of harmful substance Inhalation of harmful substance Inhalation of harmful substance - multiple episodes Inhalation of harmful substance - single episode Multiple types of exposures through skin, eyes, or other exposed tissue Nonmedical use of drugs or alcohol - unintentional overdose Repeated exposure to noise Single, brief exposure to noise Single, prolonged exposure to noise Falls, Slips & Trips Same level fall Fall on same level due to slipping Fall on same level due to tripping Fall on same level due to tripping on uneven surface Fall on same level due to tripping over an object Fall on same level due to tripping over self Fall on same level while climbing stairs, steps, or curbs Lower level fall Fall from collapsing structure or equipment Fall or jump curtailed by personal fall arrest system Fall through surface or existing opening Jump from collapsing structure or equipment Jumps to lower level Other fall to lower level Slip Trip Slip on substance without fall Slip on vehicle without fall - nontransport Slip or trip without fall Trip from stepping into a hole without fall Trip on uneven surface without fall Trip on vehicle without fall - nontransport Trip over an object without fall Trip over self without fall Trip without fall Same level fall Fall while sitting Fires & Explosions Collapsing building, structure, or structural element during fire Demolition or blasting explosion Dust explosion Explosion of nonpressurized vapors, gases, or liquids Explosion of pressure vessel, piping, or tire Explosions Fires Forest or brush fire Ignition of clothing from controlled heat source Ignition of vapors, gases, or liquids Other structural fire without collapse Small-scale (limited) fire Vehicle or machinery fire Overexertion & Bodily Reaction Body positioning Bending, crawling, reaching, twisting - repetitive or prolonged Bending, crawling, reaching, twisting - single episode Boarding, alighting - excluding slip, trip, fall - repetitive or prolonged Boarding, alighting - excluding slip, trip, fall - single episode Climbing or stepping up or down - repetitive or prolonged Climbing or stepping up or down - single episode Kneeling, kneeling down - repetitive or prolonged Kneeling, kneeling down - single episode Multiple types of exertions and bodily reactions Multiple types of overexertion involving outside sources Multiple types of overexertions and bodily reactions Multiple types of repetitive motions Overexertion Other exertions or bodily reactions Overexertion in catching - multiple episodes Overexertion in catching - single episode Overexertion in holding, carrying, or wielding Overexertion in holding, carrying, or wielding - multiple episodes Overexertion in holding, carrying, or wielding - single episode Overexertion in lifting - multiple episodes Overexertion in lifting - single episode Overexertion in lifting, lowering Overexertion in lowering - multiple episodes Overexertion in lowering - single episode Overexertion in pushing, pulling, or turning Overexertion in pushing, pulling, or turning - multiple episodes Overexertion in pushing, pulling, or turning - single episode Overexertion in throwing - multiple episodes Overexertion in throwing - single episode Overexertion in throwing, catching Overexertion involving outside sources Repetitive grasping, placing, or moving objects, except tools Repetitive motions involving microtasks Repetitive use of hands, not involving tools Repetitive use of tools, instruments Running, without other incident - repetitive or prolonged Running, without other incident - single episode Sitting, sitting down - repetitive or prolonged Sitting, sitting down - single episode Standing, standing up - repetitive or prolonged Standing, standing up - single episode Sustained viewing Typing, key entry, texting, or mousing Walking, without other incident - repetitive or prolonged Walking, without other incident - single episode Transportation Incidents Aircraft incidents Bike or scooter incident Collision between a moving and standing vehicle, nonroadway Collision between rail vehicle and another vehicle Derailment of a rail vehicle Fall on rail vehicle - transportation incident Fall or jump from and struck by another vehicle in normal operation, nonroadway Fall or jump from and struck by another vehicle in normal operation, roadway Fall or jump from and struck by rail vehicle - transportation incident Fall or jump from and struck by same vehicle in normal operation, nonroadway Fall or jump from and struck by same vehicle in normal operation, roadway Fall or jump from rail vehicle - transportation incident Fall or jump from vehicle in normal operation, nonroadway Fall or jump from vehicle in normal operation, roadway Jack-knifed or overturned, nonroadway Jack-knifed or overturned, roadway Moving in opposite directions, oncoming, nonroadway Moving in same direction, nonroadway Nonroadway collision with other vehicle Nonroadway collisions with object other than vehicle Nonroadway incidents involving motorized land vehicles Nonroadway noncollision incident Part of occupant body caught between vehicle and other object in nonroadway Pedestrian struck by forward-moving vehicle in nonroadway area Pedestrian struck by forward-moving vehicle in roadway Pedestrian struck by forward-moving vehicle in work zone Pedestrian struck by forward-moving vehicle on side of road Pedestrian struck by rail vehicle - transportation incident Pedestrian struck by vehicle backing up in nonroadway area Pedestrian struck by vehicle backing up in roadway Pedestrian struck by vehicle backing up in work zone Pedestrian struck by vehicle backing up on side of road Pedestrian struck by vehicle in nonroadway area Pedestrian struck by vehicle in roadway Pedestrian struck by vehicle in work zone Pedestrian struck by vehicle on side of road Pedestrian struck by vehicle propelled by another vehicle in nonroadway area Pedestrian struck by vehicle propelled by another vehicle in work zone Pedestrian struck by vehicle propelled by another vehicle on side of road Pedestrian vehicular incidents Rail vehicle incidents Ran off driving surface, nonroadway Ran off roadway Roadway collision - moving and standing vehicle in roadway Roadway collision - moving and standing vehicle on side of roadway Roadway collision - moving in opposite directions, oncoming Roadway collision - moving in same direction Roadway collision - moving perpendicularly Roadway collision with object other than vehicle Roadway collision with other vehicle Roadway noncollision incident Struck bump, hole, or rough terrain in road surface Struck bump, hole, rough terrain on driving surface, nonroadway Struck by shifting load during transport, nonroadway Struck by shifting load during transport, roadway Sudden start or stop, nonroadway Sudden start or stop, roadway Vehicle struck by falling or flying object - roadway Vehicle struck object or animal in roadway Vehicle struck object or animal on side of roadway Violence & Other Injuries by Persons or Animals Animal and insect related incidents Bitten and or struck by animal Drug overdose Injury by other person - intentional Injury by other person - unintentional or intent unknown Nonvenomous stings and bites Self-inflicted injury - intentional Self-inflicted injury - unintentional or intent unknown Venomous Stings and Bites
125. Treatment ClassificationList Radio
Jobsite Treatment Offsite Medical Treatment Treatment Decilined by Injured Party
126. Medical Treatment ProviderList Radio
REMEMBER TO CALL OCCUCARE FIRST FOR NON EMERGENCY INJURIES INVOLVING SUNDT PERSONNEL 866-268-0884
Occupational Health Clinic Hospital / Emergency Room / EMS (911) After Hours / Urgent Care
127. First Aid ProviderList Radio
Occucare Jobsite First Aid Provider (i.e. Project Site Nurse, etc.) Project personnel Self administered
128. Treatment OutcomeList Radio
STCKY Injury - Select SIF criteria from the box below.
First Aid Restricted Duty Days Away from work / Lost Time Other Recordable Criteria - Other Recordable Criteria = prescriptions, therapy, etc., Anything other than Restricted Duty or Lost Time STCKY Injury - STCKY Injury - Life Threatening (LT) - Worker would not survive without medical intervention
129. STCKY Injury - SIF CriteriaList Radio
Fatality Amputations (involving bone) excludes distal phalanx Head trauma that results in a traumatic brain injury (TBI) Injury or trauma to vital organs Bone fractures requiring surgery for repair, excluding fingers and toes Acute traumatic herniated disc with neurologic deficit 3rd degree burn requiring skin graft Eye injuries resulting in permanent vision loss or change in vision High pressure injection injuries requiring surgical debridement and irrigation Heat Stroke – Medically diagnosed Electrical Contact Injury – Resulting in life-threatening cardiac, neurological, or burn injuries requiring emergency or hospital-level care Vascular trauma requiring surgery Acute chemical or radiological exposure resulting in injury to vital organs Other Injuries
130. Injury Classification: First AidText Label
131. Injury Classification: RecordableText Label
132. Clinic Hospital NameText Short
133. Clinic Hospital AddressText Short
134. Clinic Hospital Phone NumberText Short
135. First day of lost timeDate
136. Has lost time ended?List Drop-down
137. First day of modified dutyDate
138. Date returned to modified dutyDate
139. Date returned to regular workDate
140. Employment Termination DateDate
141. Miscellaneous Injury Notes / Other Recordable Criteria:Text Short
142. Employee NumberText Short
Input a single 0 if unknown
143. Date of BirthDate
input today's date if unknown
144. Date of HireDate
input today's date if unknown
145. Current, Physical Address (Street name & number, city, state, zip)Text Short
input a 0 if unknown
146. Hourly WageNumber
147. Side of Body InjuredList Radio
Right Left Both
148. GenderList Radio
Male Female
149. Name of physician or healthcare professionalText Short
150. Was employee hospitalized overnight as an in-patient?List Radio
Yes No
151. What was the employee doing just before the incident occurred?Text Short
152. If the employee died, when did death occur?Date time

## 6. Equipment, Vehicle, Property #1

click to collapse/expand
Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
153. OwnerList Radio
Who is the owner/responsible person for the equipment/vehicle/property?
Client Sundt Trade Contractor Third Party Other
154. Equipment CategoryList Drop-down
155. Equipment or Property Description/Make/Model/License Plate/etcText Short
156. Equipment DisplayIntegrated list
157. Equipment DescriptionIntegrated list
158. Third Party's Insurance InfoText Short
Company, policy number, ID, insured, etc.
159. Third Party's Driver License #Text Short
160. Description of Damage/LossText Short
161. Work Order Cost TypeText Short
162. Issued Work Order NumberText Short
163. Value of Damage/LossList Radio
Under $1k Over $1k N/A or none
164. Was business interrupted?List Radio
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.
Yes business interrupted No business interruption
165. Estimated Value of Damage/LossNumber
166. Incident occurred duringList Radio
Mobile equipment repair / maintenance n/a

## 7. Equipment, Vehicle, Property #2

click to collapse/expand
Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
167. OwnerList Radio
Who is the owner/responsible person for the equipment/vehicle/property?
Client Sundt Trade Contractor Third Party Other
168. Equipment CategoryList Drop-down
169. Equipment or Property Description/Make/Model/License Plate/etcText Short
170. Equipment DisplayIntegrated list
171. Equipment DescriptionIntegrated list
172. Third Party's Insurance InfoText Short
Company, policy number, ID, insured, etc.
173. Third Party's Driver License #Text Short
174. Description of Damage/LossText Short
175. Work Order Cost TypeText Short
176. Issued Work Order NumberText Short
177. Value of Damage/LossList Radio
Under $1k Over $1k N/A or none
178. Was business interrupted?List Radio
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.
Yes business interrupted No business interruption
179. Estimated Value of Damage/LossNumber
180. Incident occurred duringList Radio
Mobile equipment repair / maintenance n/a

## 8. Equipment, Vehicle, Property #3

click to collapse/expand
Use the "Crane" section for any crane-related equipment documentation. Use the "Utility Damage" section for utility property damage.
181. OwnerList Radio
Who is the owner/responsible person for the equipment/vehicle/property?
Client Sundt Trade Contractor Third Party Other
182. Equipment CategoryList Drop-down
183. Equipment or Property Description/Make/Model/License Plate/etcText Short
184. Equipment DisplayIntegrated list
185. Equipment DescriptionIntegrated list
186. Third Party's Insurance InfoText Short
Company, policy number, ID, insured, etc.
187. Third Party's Driver License #Text Short
188. Description of Damage/LossText Short
189. Work Order Cost TypeText Short
190. Issued Work Order NumberText Short
191. Value of Damage/LossList Radio
Under $1k Over $1k N/A or none
192. Was business interrupted?List Radio
For example: A fiber optic/gas/electrical utility was damaged by construction activities which caused outage for nearby businesses.
Yes business interrupted No business interruption
193. Estimated Value of Damage/LossNumber
194. Incident occurred duringList Radio
Mobile equipment repair / maintenance n/a

## 9. Crane #1 Information

click to collapse/expand
195. Crane OwnerList Radio
Sundt Trade Contractor Third Party / Rental / Crane Service Company
196. Sundt Crane IDList Drop-down
197. Identity of Crane Owner/Responsible Party:Text Short
198. Crane TypeList Drop-down
199. Crane Make & ModelText Short
200. Did the crane incur damage as a result of this incident?List Radio
Yes, crane incurred damage No damage
201. Value of Crane Damage/LossList Radio
Under $1k Over $1k
202. Estimated Value of Crane Damage/LossNumber
203. Did incident occur during repair or maintenance?List Radio
Yes No
204. Did incident occur during assembly/disassembly?List Radio
Yes No
205. Was an A/D Director present at the time of incident?Choice
Yes No
206. A/D Director - Type First and Last NameText Short
207. Has a Qualified Crane Manager been identified for the project?Choice
Yes No
208. Qualified Crane Manager - Type First and Last NameText Short
209. Was the Lift Director on site?Choice
Yes No
210. Lift Director - first and last nameText Short
211. Was the operator authorized by Sundt?Choice
Yes No
212. Any crane plans need revision?List Checkbox
n/a Assembly/Disassembly Plan Lift Plan Move Plan

## 10. Crane #2 Information

click to collapse/expand
213. Crane OwnerList Radio
Sundt Trade Contractor Third Party / Rental / Crane Service Company
214. Sundt Crane IDList Drop-down
215. Identity of Crane Owner/Responsible Party:Text Short
216. Crane TypeList Drop-down
217. Crane Make & ModelText Short
218. Did the crane incur damage as a result of this incident?List Radio
Yes, crane incurred damage No damage
219. Value of Crane Damage/LossList Radio
Under $1k Over $1k
220. Estimated Value of Crane Damage/LossNumber
221. Did incident occur during repair or maintenance?List Radio
Yes No
222. Did incident occur during assembly/disassembly?List Radio
Yes No
223. Was an A/D Director present at the time of incident?Choice
Yes No
224. A/D Director - Type First and Last NameText Short
225. Has a Qualified Crane Manager been identified for the project?Choice
Yes No
226. Qualified Crane Manager - Type First and Last NameText Short
227. Was the Lift Director on site?Choice
Yes No
228. Lift Director - first and last nameText Short
229. Was the operator authorized by Sundt?Choice
Yes No
230. Any crane plans need revision?List Checkbox
n/a Assembly/Disassembly Plan Lift Plan Move Plan

## 11. Utility #1 Damage

click to collapse/expand
231. Utility LocationList Radio
Underground Above ground Overhead
232. Utility InstallationList Radio
Existing Job Installed
233. Utility TypeList Radio
Communication, cable, tv, alarm, signal Electric, Power, Lighting Gas, oil, steam petroleum, or gaseous materials Hydronic Potable water Reclaimed water, irrigation Sewer Other Fire Sprinkler
234. If other, write in utility type:Text Short
235. Right of Way OwnerText Short
236. Utility Owner NameText Short
237. Was a Disturbance Permit in place for this activity?List Radio
Yes No Not applicable
238. Was the utility de-energized?List Radio
Yes No N/A or TBD
239. Was a spotter used?List Radio
Yes No N/A or TBD
240. Was the utility accurately located/marked?List Radio
Yes No Not applicable
241. Why wasn't the utility accurately located/marked?Text Short
242. Dig Alert / Call 811 / Locate TicketAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
243. Disturbance PermitAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
244. Value of Damage/LossList Radio
Under $1k Over $1k
245. Was business interrupted?List Radio
Yes business interrupted No business interruption
246. Estimated Value of Damage/LossNumber

## 12. Utility #2 Damage

click to collapse/expand
247. Utility LocationList Radio
Underground Above ground Overhead
248. Utility InstallationList Radio
Existing Job Installed
249. Utility TypeList Radio
Communication, cable, tv, alarm, signal Electric, Power, Lighting Gas, oil, steam petroleum, or gaseous materials Hydronic Potable water Reclaimed water, irrigation Sewer Other Fire Sprinkler
250. If other, write in utility type:Text Short
251. Right of Way OwnerText Short
252. Utility Owner NameText Short
253. Was a Disturbance Permit in place for this activity?List Radio
Yes No Not applicable
254. Was the utility de-energized?List Radio
Yes No N/A or TBD
255. Was a spotter used?List Radio
Yes No N/A or TBD
256. Was the utility accurately located/marked?List Radio
Yes No Not applicable
257. Why wasn't the utility accurately located/marked?Text Short
258. Dig Alert / Call 811 / Locate TicketAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
259. Disturbance PermitAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
260. Value of Damage/LossList Radio
Under $1k Over $1k
261. Was business interrupted?List Radio
Yes business interrupted No business interruption
262. Estimated Value of Damage/LossNumber

## 13. Water Intrusion

click to collapse/expand
263. Select the classificationList Radio
Minor - We can clean up the water and remove ALL wet materials off the site Serious - We are not sure how far the water traveled and we are going to have to call for remediation. ---> Immediately call Maree Urias Buono (520) 709-6964 - Immediately call Maree Urias Buono (520) 709-6964
264. What to do in the event of water intrusionReference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
265. Status of structures/materials subjected to intrusionList Radio
Less than 24 hrs, up to 48 hrs More than 48 hrs with no visible growth Visible growth
266. Surface area affectedList Radio
Level 1: Less than 10 square feet Level 2: 10-30 square feet Level 4: More than 100 square feet Level 5A & 5B Remediation HVAC
267. Building occupancy statusList Radio
Occupied building Non-occupied building
268. What caused the intrusion?List Radio
Weather related Utility related
269. Remediation ContractorText Short
270. Industrial HygienistText Short
271. LabText Short
272. Investigate and evaluate moisture and mold problemsList Checkbox
Assess size of moldy area (square feet) Consider the possibility of hidden mold Clean up small mold problems and fix moisture problems before they become large problems Select a remediation manager for medium or large size mold problem Investigate areas associated with occupant complaints Identify source(s) or cause(s) of water or moisture problem(s) Note type of water-damaged materials (wallboard, carpet, etc.) Check inside air ducts and air handling unit(s) Throughout process, consult a qualified professional if necessary or desired Immediately report the event to Sundt’s HS&E Department to determine if insurance coverage exists through Sundt, Owner, or subcontractor’s insurance programs.
273. Communicate with building occupants at all stages of process, as appropriateList Checkbox
Designate contact person for questions and comments about medium or large-scale remediation as needed Arrange for comparable temporary facilities for occupants during remediation
274. Plan remediationList Checkbox
Adapt/modify remediation guidelines for the situation; use professional judgment Plan to dry wet, non-moldy materials within 48 hours to prevent mold growth Select cleanup methods for moldy items Select Personal Protection Equipment - protect remediators Select containment equipment - protect building occupants Select remediation personnel who have the experience and training needed to implement the Remediation plan and use Personal Protection Equipment and containment as appropriate
275. Remediate moisture and mold problemsList Checkbox
Fix moisture problem, implement repair plan and/or maintenance plan Dry wet, non-moldy materials within 48 hours to prevent mold growth Clean and dry moldy materials Discard moldy porous items that can't be cleaned
276. Other remedial actions takenText Short

## 14. STCKY Causal Analysis: S#!t That's Built at Heights

click to collapse/expand
277. Safe access provided to elevated work area?List Radio
Walking Surfaces | Stairs | Ramps: Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards Landings of not less than 30 inches Uniform riser height and tread depth No hazardous projections: protruding nails Proper Handrail Installed For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1052 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1052) Ladders – Ladders - Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards In good condition At least a Type 1A (rated for up to 300 pounds) Constructed of nonconductive material Setup at a 4:1 angle Secured | tied off to prevent movement Extend 3ft beyond landing area or have “pass through” gate Protected from fall exposure by means of a controlled access point Be used per the manufacturer’s instructions For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053) Elevated work platform Inspected and maintained Designed for intended use Fall protection system in place
Yes No Not applicable
278. Safe access - Corrective ActionsList Checkbox
Walking Surfaces - Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards Install Proper Handrail Ladders - Relentless Housekeeping - Access | Egress free from obstructions, tripping hazards Replace ladder with at least a Type 1A (rated for up to 300 pounds) Replace with ladder Constructed of nonconductive material Install ladder at a 4:1 angle Secure | tie off ladder to prevent movement Extend ladder 3ft beyond landing area or install “pass through” gate Protect workers from fall exposure by means of a controlled access point MEWP - Review and train per the manufacturer’s instructions MEWP - Inspect and maintain elevated work platform MEWP - Use per intended design MEWP - Install fall protection system
279. Reason for lack of Safe AccessList Radio
Safe access hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Safe access control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Safe access control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Safe access control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
280. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
281. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
282. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
283. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
284. Fall prevention measures adequate?List Radio
Yes No Not applicable
285. Fall Prevention - Corrective ActionsList Checkbox
Install Top rails at 42” Install Mid-rails at 21” Tension Wire rope < 3” deflection Install guard rail system capable of withstanding 200lbs. of force Install rated hole covering or standard guardrail system to protect openings larger than 2" Ensure hole coverings are secured to prevent displacement Replace hole covering with one capable of supporting 2X max. intended load Mark, using High Visible paint, “HOLE” or “COVER” Cal/OSHA - requires hole covers to bear a pressure sensitized, painted, or stenciled sign with legible letters not less than one inch high, stating: “Opening--Do Not Remove.” Install guardrail system for holes |openings > greater than 24” wide. Ensure vertical supports max. 8’ apart with top rail, midrail, and toe boards. Verify Employees trained on fall protection procedures Installed C.A.Z. min. 6’ back from edge of deck | floor | wall opening. Ensure 100% Fall protection required when employees cross flagging
286. Reason for lack of Fall PreventionList Radio
Fall Prevention hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Fall Prevention control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Fall Prevention control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Fall Prevention control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
287. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
288. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
289. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
290. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
291. Personal fall protection properly used?List Radio
Yes No Not applicable
292. Personal Fall Protection - Corrective ActionsList Checkbox
Select/Install anchor point rated for 5000 lbs or greater Select leading edge rated lanyard Ensure fall harness properly donned and inspected Ensure 100% Tie off Ensure adequate fall clearance from lower level | obstructions Review rescue plan / ensure rescue equipment in place
293. Reason for lack of Personal Fall ProtectionList Radio
Personal Fall Protection hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Personal Fall Protection control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Personal Fall Protection control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Personal Fall Protection control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
294. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
295. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
296. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
297. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
298. Dropped object protection in place?List Radio
Yes No Not applicable
299. Dropped object protection - Corrective ActionsList Checkbox
Tether tools and materials while working near leading edge Remove unneeded tools from elevated work area Establish C.A.Z. with physical barriers with adequate signage Remove workers from hazard area, set up adequate C.A.Z. Designate spotter for C.A.Z. when signage is not being used Secure/Net material hoisted over active work areas Repair | Install netting | screening Install overhead protection at entrances/exits Remove | secure | distance materials within 6ft. of leading edge
300. Reason for lack of Dropped Object ProtectionList Radio
Dropped Object hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Dropped Object control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Dropped Object control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Dropped Object control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
301. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
302. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
303. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
304. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 15. STCKY Causal Analysis: S#!t That Stores Energy

click to collapse/expand
305. Personnel protected from the release of stored energy (Material and Tools)?List Radio
Stored energy identified Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work
Yes No Not applicable
306. Stored Energy (Material and Tools) - Corrective ActionsList Checkbox
Identify stored energy Implement line of fire protection in place (PPE, barricading, spacing) Establish safeguards for release of stored energy Ensure “Zero energy”, test prior to continuing work
307. Reason for lack of Stored Energy (Material and Tools) controlsList Radio
Stored Energy (Material/Tools) hazard(s) not recognized Stored Energy (Material/Tools) control(s) not identified Stored Energy (Material/Tools) control(s) not implemented Stored Energy (Material/Tools) control(s) not executed
308. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
309. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
310. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
311. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
312. Personnel protected from the release of stored energy? (Mechanical Equipment - Non-electrical)List Radio
Stored energy identified Inspected and maintained Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work
Yes No Not applicable
313. Stored Energy (Mechanical Equipment - Non-electrical) - Corrective ActionsList Checkbox
Identify stored energy Inspect and maintain sources of stored energy Implement line of fire protection in place (PPE, barricading, spacing) Establish safeguards for release of stored energy Ensure “Zero energy”, test prior to continuing work
314. Reason for lack of Stored Energy controls (Mechanical Equipment - Non-electrical)List Radio
Stored Energy (Mech. Equip., Non-Electrical) hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Stored Energy (Mech. Equip., Non-Electrical) control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Stored Energy (Mech. Equip., Non-Electrical) control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Stored Energy (Mech. Equip., Non-Electrical) control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
315. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
316. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
317. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
318. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
319. Personnel protected from the release of stored energy? (Systems - Non-electrical)List Radio
Stored energy identified Designed for intended use Inspected and maintained Line of fire protection in place (PPE, barricading, spacing) Proper safeguards established for release of energy “Zero energy” tested prior to continuing work
Yes No Not applicable
320. Stored Energy (Systems - Non-electrical) - Corrective ActionsList Checkbox
Identify stored energy Ensure system is designed for intended use Inspect and maintain system Implement line of fire protection (PPE, barricading, spacing) Establish proper safeguards for release of energy Ensure “Zero energy”, test prior to continuing work
321. Reason for lack of Stored Energy controls (Systems- Non-electrical)List Radio
Stored Energy (Systems, Non-Electrical) hazard(s) not recognized - Hazard(s) Not Recognized Hazard(s) not recognized by employees involved in the task. Example: Dropped object hazard(s) not recognized by the crew. Stored Energy (Systems, Non-Electrical) control(s) not identified - Control(s) Not Identified Control(s) not identified for the recognized hazard(s) Example: The crew did not identify the need for tethers, C.A.Z. (Controlled Access Zone), etc., to protect from recognized dropped object hazards. Stored Energy (Systems, Non-Electrical) control(s) not implemented - Control(s) Not Implemented Identified control(s) were not implemented. Example: C.A.Z. identified as a control for dropped object hazard(s), but not established (implemented). Stored Energy (Systems, Non-Electrical) control(s) not executed - Control(s) Not Executed Implemented control(s) were not properly executed. Example: C.A.Z. was established but not enforced (executed).
322. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
323. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
324. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
325. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 16. STCKY Causal Analysis: S#!t That's Built in Confined Spaces

click to collapse/expand
326. Confined Space IdentificationList Radio
"Confined space" means a space that: (1) Is large enough and so configured that an employee can bodily enter and perform assigned work; and (2) Has limited or restricted means for entry or exit (for example, tanks, vessels, silos, storage bins, hoppers, vaults, and pits are spaces that may have limited means of entry.); and (3) Is not designed for continuous employee occupancy. "Non-permit confined space" means a confined space that does not contain or, with respect to atmospheric hazards, have the potential to contain any hazard capable of causing death or serious physical harm. "Permit-required confined space (permit space)" means a confined space that has one or more of the following characteristics: (1) Contains or has a potential to contain a hazardous atmosphere; (2) Contains a material that has the potential for engulfing an entrant; (3) Has an internal configuration such that an entrant could be trapped or asphyxiated by inwardly converging walls or by a floor which slopes downward and tapers to a smaller cross-section; or (4) Contains any other recognized serious safety or health hazard.
Non-permit Required Permit Required
327. Space's air tested to verify Non-Permit classification?List Radio
Air tested to verify no atmospheric hazards present.
Yes No
328. Non-permit required Confined Space: Air Testing - Corrective ActionsList Checkbox
Verify "Non-Permit" classification with air testing Review permit. Test atmosphere. Re-classify confined space
329. Reason for lack of air testingList Radio
Air Monitoring(s) not recognized Air Monitoring(s) not identified Air Monitoring(s) not implemented Air Monitoring(s) not executed
330. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
331. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
332. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
333. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
334. Permit Required Confined Space: Hazardous atmosphere controls in place?List Radio
Air Monitoring: Confined space air tested prior to entry and monitored during shift with calibrated monitor Adequate ventilation maintained
Yes No
335. Permit Required Confined Space: Hazardous Atmosphere Controls - Corrective ActionsList Checkbox
Test confined space air with calibrated air monitor Provide adequate ventilation
336. Reason for lack of hazardous atmosphere controlsList Radio
Air Monitoring(s) not recognized Air Monitoring(s) not identified Air Monitoring(s) not implemented Air Monitoring(s) not executed
337. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
338. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
339. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
340. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
341. Non-permit Required Confined Space: Safe access provided into space?List Radio
Safe Access: PPE and equipment for safe entry available Employees properly using entry equipment https://www.osha.gov/laws-regs/federalregister/2015-05-04 (https://www.osha.gov/laws-regs/federalregister/2015-05-04)
Yes No
342. Non-permit Required Confined Space: Safe access - Corrective ActionList Checkbox
Provide PPE and equipment for safe entry Train employees in use of PPE
343. Reason for lack of confined space accessList Radio
Safe access hazard(s) not recognized Safe access control(s) not identified Safe access control(s) not implemented Safe access control(s) not executed
344. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
345. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
346. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
347. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
348. Permit Required Confined Space: Safe access provided into permit required space?List Radio
Safe Access: Required signage and permitting in place PPE and equipment for safe entry available Employees properly using entry equipment Confined Space Attendant stationed outside during operations https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.146 (https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.146)
Yes No
349. Permit Required Confined Space: Safe access - Corrective ActionList Checkbox
Post required signage and complete permitting Provide PPE and equipment for safe entry Train employees on use of PPE Provide Confined Space Attendant at access during operations
350. Reason for lack of safe access into confined spaceList Radio
Safe access hazard(s) not recognized Safe access control(s) not identified Safe access control(s) not implemented Safe access control(s) not executed
351. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
352. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
353. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
354. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
355. Permit Required Confined Space: Method of communication with entrants established and maintained?List Radio
Radio or visual means of communication established with entrants tested and verified
Yes No
356. Permit Required Confined Space: Method of communication - Corrective ActionList Checkbox
Establish means of radio or visual communication with entrants Test communication system
357. Reason for lack of communication methodList Radio
Communication(s) not recognized Communication(s) not identified Communication(s) not implemented Communication(s) not executed
358. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
359. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
360. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
361. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
362. Permit Required Confined Space: Emergency Procedures in place?List Radio
Emergency Response: Emergency numbers available Rescue equipment available
Yes No
363. Permit Required Confined Space: Emergency Procedures - Corrective ActionsList Checkbox
Post emergency numbers Secure rescue equipment
364. Reason for lack of emergency proceduresList Radio
Emergency Response not recognized Emergency Response not identified Emergency Response not implemented Emergency Response not executed
365. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
366. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
367. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
368. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 17. STCKY Causal Analysis: S#!t That's Built Underground

click to collapse/expand
369. Utility strike prevention measures in place?List Radio
Active, refreshed dig ticket Service/lateral lines are located. Existing Utilities are located and marked Potholing used to verify the location and depth of the utility Potholed utilities marked, protected, supported, or removed
Yes No Not applicable
370. Utility Strike Prevention - Corrective ActionsList Checkbox
Activate or refresh dig ticket Locate service/lateral lines Locate and mark existing utilities Pothole to verify the location and depth of the utility Mark, protect, support, or remove verified utilities
371. Reason for lack of utility strike prevention measuresList Radio
Utility Strike hazard(s) not recognized Utility Strike control(s) not identified Utility Strike control(s) not implemented Utility Strike control(s) not executed
372. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
373. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
374. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
375. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
376. Atmosphere within excavation verified as safe for work?List Radio
Atmosphere within the excavation tested Testing conducted at regular intervals to ensure that the atmosphere remains safe Precautions taken to protect employees from exposure to hazardous atmospheres Emergency equipment readily available Employees trained to use personal protective and rescue equipment
Yes No
377. Atmosphere within excavation - Corrective ActionsList Checkbox
Test atmosphere within the excavation Conduct testing at regular intervals to ensure that the atmosphere remains safe Take precautions to protect employees from exposure to hazardous atmospheres Provide Emergency equipment and make readily available Train employees to use personal protective and rescue equipment
378. Reason for lack of excavation air testingList Radio
Environmental hazard(s) not recognized Environmental control(s) not identified Environmental control(s) not implemented Environmental control(s) not executed
379. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
380. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
381. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
382. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
383. Safe access to the work area?List Radio
Safe means of access/egress available? Provide safe means of access/egress for workers in trench/excavations 4’ or deeper Provide safe access/egress available within 25‘ of lateral travel Bridges with handrails across trenches wider than 30” Relentless Housekeeping - Maintain access/egress clear of obstructions Install Barricade/Flagging/Fencing 6ft. from leading edge Provide Fall protection available for workers near leading edge Ladders – Access/Egress free from obstructions, tripping hazards No damage on rails or rungs At least a Type 1A (rated for up to 300 pounds) Constructed of nonconductive material Setup at a 4/1 angle Secured/tied off to prevent movement Extend 3ft beyond landing area or have “pass through” gate Protected from fall exposure by means of a controlled access point Be used per the manufacturer’s instructions For more information see: https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053 (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
384. Safe access - Corrective ActionsList Checkbox
Install Barricade/Flagging/Fencing 6ft. from leading edge Provide Fall protection available for workers near leading edge Provide safe means of access/egress for workers in trench/excavations 4’ or deeper Provide safe access/egress available within 25' of lateral travel Ramps - Relentless Housekeeping - Maintain access/egress clear of obstructions Ladders - Relentless Housekeeping - Maintain access/egress clear of obstructions Replace ladder Utilize ladder meeting Type 1A (rated for up to 300 pounds) Supply ladder constructed of nonconductive material Setup ladder at a 4/1 angle Secure/tie off ladder to prevent movement Extend ladder 3ft beyond landing area or have “pass through” gate Protect workers from fall exposure by means of a controlled access point Use ladder per the manufacturer’s instructions Install bridges with handrails across trenches wider than 30”
385. Reason for lack of safe excavation accessList Radio
Safe access hazard(s) not recognized Safe access control(s) not identified Safe access control(s) not implemented Safe access control(s) not executed
386. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
387. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
388. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
389. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
390. Cave-in protection in place?List Radio
Cave in protection - Excavations 5’ deep or greater have protective system Excavations greater than 20’ designed by professional engineer Spoils, materials, and equipment set back at least 2’ excavation edge Loose rock or soil at excavation face sealed back Accumulation of water controlled Sloping / Benching – Sloping/Benching appropriate for soil classification Type A Soil - ¾:1 If 12’ or less and open for less than 24 hrs. Type B Soil – 1:1 Type C Soil - 1 ½:1 (type C soil cannot be benched) Trench Box or Shield – Tabulated Data on site Box placed to prevent lateral movement Box extends 18” above excavation Box no more than 24” from bottom of excavation Hydraulic Shoring – Tabulated Data on site Horizontal spacing per tabulated data (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
391. Cave in Protection - Corrective ActionsList Checkbox
Install protective system for excavations 5’ deep or greater Secure design document for excavations greater than 20' Set back spoils, materials, and equipment least 2’ excavation edge Seal back loose rock or soil at excavation face Prevent accumulation of water Ensure sloping/benching appropriate for soil classification Type A Soil - ¾:1 If 12’ or less and open for less than 24 hrs. Type B Soil – 1:1 Type C Soil - 1 ½:1 (type C soil cannot be benched) Ensure tabulated data on site Place box to prevent lateral movement Position box to extend 18” above excavation Position box so that it is no more than 24” from bottom of excavation Hydraulic Shoring - Ensure Tabulated Data on site Hydraulic Shoring - Install horizontal spacing per tabulated data
392. Reason for lack of cave-in protectionList Radio
Cave in hazard(s) not recognized Cave in control(s) not identified Cave in control(s) not implemented Cave in control(s) not executed
393. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
394. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
395. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
396. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 18. STCKY Causal Analysis: S#!t That's Moves or Crushes

click to collapse/expand
397. Ground personnel protected from moving jobsite equipment?List Radio
Equipment logistics plan in place and executed First move forward being utilized Separate access routes for equipment and personnel established Properly trained and positioned spotters (if required) Blind spots identified and protected Crush points identified and protected Ground personnel using positive visual confirmation before approaching equipment (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
398. Protection from moving jobsite equipment - Corrective ActionsList Checkbox
Develop and implement logistics plan Implement First move forward Establish separate access routes for equipment and personnel Train and position spotters (if required) Identify and protect blind spots Identify and protect crush points Implement positive visual confirmations for ground personnel before approaching equipment
399. Reason for lack of protection for ground personnelList Radio
Moving Equipment hazard(s) not recognized Moving Equipment control(s) not identified Moving Equipment control(s) not implemented Moving Equipment control(s) not executed
400. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
401. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
402. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
403. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
404. Workers protected while working near/adjacent to live traffic?List Radio
Traffic control plan in place Equipment/Vehicles positioned to protect workers Workers wearing all required PPE Safe access to work zone available (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
405. Working near/adjacent to live traffic - Corrective ActionsList Checkbox
Implement approved Traffic control plan Position Equipment/Vehicles to protect workers from live traffic Provide required PPE Provide Safe access to work zone
406. Reason for lack of protection from live trafficList Radio
Live Traffic hazard(s) not recognized Live Traffic control(s) not identified Live Traffic control(s) not implemented Live Traffic control(s) not executed
407. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
408. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
409. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
410. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
411. Safe procedures in place for work/travel near overhead utilities?List Radio
Traffic control plan in place Equipment/Vehicles positioned to protect workers Workers wearing all required PPE Safe access to work zone available (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
412. Work/travel near overhead utilities - Corrective ActionsList Checkbox
Conduct planning meeting (discuss de-energizing lines) Erect signs and barricades Erect warning lines Provide Non-conductive tag lines Designate spotter as required Ensure minimum clearance distance per Table A
413. Reason for lack of protection near overhead utilitiesList Radio
Overhead Utility hazard(s) not recognized Overhead Utility control(s) not identified Overhead Utility control(s) not implemented Overhead Utility control(s) not executed
414. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
415. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
416. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
417. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 19. STCKY Causal Analysis: S#!t That's Hazardous

click to collapse/expand
418. Safe handling, use, and storage of hazardous materials?List Radio
SDS available and reviewed Appropriate PPE identified, provided, and in use Spill/emergency response procedures in place (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
419. Handling and use of hazardous materials - Corrective ActionsList Checkbox
Provide and review SDS Obtain and provide appropriate PPE Develop and implement emergency spill procedures Post required signage and labels Implement fire protection measures Eliminate ignition sources Properly store hazardous material per SDS
420. Reason for lack of hazmat protocolsList Radio
Hazardous Material hazard(s) not recognized Hazardous Material control(s) not identified Hazardous Material control(s) not implemented Hazardous Material control(s) not executed
421. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
422. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
423. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
424. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
425. Heat illness prevention measures in place?List Radio
Project specific procedures for heat illness prevention being followed Ice is available Cool water is available within reasonable walking distance Rehydration drinks/pops/powders available Heat illness kit available Shade provided close to the work area OSHA - Heat Illness Prevention: https://www.osha.gov/heat (https://www.osha.gov/heat) OSHA – NIOSH Heat Safety Tool - Download: https://apps.apple.com/us/app/osha-niosh-heat-safety-tool/id1239425102 (https://apps.apple.com/us/app/osha-niosh-heat-safety-tool/id1239425102) (https://www.osha.gov/laws-regs/regulations/standardnumber/1926/1926.1053)
Yes No Not applicable
426. Heat Illness Prevention - Corrective ActionsList Checkbox
Develop Project specific procedures for heat illness prevention Provide ice Provide cool water within reasonable walking distance Get a heat illness kit for emergency response Set up shade area close to the work area
427. Reason for lack of heat illness preventionList Radio
Heat Illness hazard(s) not recognized Heat Illness control(s) not identified Heat Illness control(s) not implemented Heat Illness control(s) not executed
428. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
429. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
430. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
431. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 20. STCKY Causal Analysis: S#!t That's Energized

click to collapse/expand
432. Tools, cords, and leads in proper condition?List Radio
Rated for intended use Cord insulation intact Properly grounded
Yes No Not applicable
433. Tools, cords, and leads - Corrective ActionsList Checkbox
Obtain tools, cords, and leads rated for intended use Repair cord insulation by qualified person Properly ground tools, cords, and leads
434. Reason for lack of tools, cords, or leads conditionList Radio
Tool, cord, lead hazard(s) not recognized Tool, cord, lead control(s) not identified Tool, cord, lead control(s) not implemented Tool, cord, lead control(s) not executed
435. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
436. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
437. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
438. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
439. Electrical sources, generators, welders, light plants safe to use?List Radio
Rated for intended use Grounded and/or functional GFCI Conductors insulated or protected from contact
Yes No Not applicable
440. Electrical sources, generators, welders, light plants - Corrective ActionsList Checkbox
Obtain tools, cords, and leads rated for intended use Ground equipment or install functional GFCI Insulate or protect conductors from contact
441. Reason for lack of electrical protection (sources, generators, welders, light plants)List Radio
Electrical Sources hazard(s) not recognized Electrical Sources control(s) not identified Electrical Sources control(s) not implemented Electrical Sources control(s) not executed
442. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
443. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
444. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
445. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
446. Energized systems procedures in place?List Radio
Correct PPE provided for operation Work performed by qualified person Hazardous or residual energy identified and locked out System/Equipment has been “zero energy” tested prior to work
Yes No Not applicable
447. Energized systems procedures - Corrective ActionsList Checkbox
Provide correct PPE for operation Assign work to qualified person Identify and Lock Out hazardous or residual energy Test system/equipment for "zero" energy
448. Reason for lack of energized systems proceduresList Radio
Energized System hazard(s) not recognized Energized System control(s) not identified Energized System control(s) not implemented Energized System control(s) not executed
449. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
450. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
451. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
452. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 21. STCKY Causal Analysis: S#!t That Lifts

click to collapse/expand
453. Load Handling Equipment ClassificationList Radio
Cranes Other Load Handling Devices (equipment with forks, hoists, etc)
454. Required Crane set up procedures in place?List Radio
Underground hazards identified and marked Ground rated for load Ground conditions firm, drained, and graded Outriggers extended as required by load chart Floats level, cribbing/matting sufficient Swing radius protection in place
Yes No
455. Cranes Set Up - Corrective ActionsList Checkbox
Identify and mark underground hazards Verify ground is rated for load Ensure ground conditions are safe for operation Extend outriggers as required by load chart Ensure Floats are level and cribbing/matting is sufficient Protect swing radius barricade
456. Reason for lack of crane set upList Radio
Crane Set Up hazard(s) not recognized Crane Set Up control(s) not identified Crane Set Up control(s) not implemented Crane Set Up control(s) not executed
457. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
458. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
459. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
460. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
461. Safe procedures for work near overhead utilities? (Cranes)List Radio
Overhead Utilities: For work near powerlines: All of the following must be met: Planning meeting (discuss de-energizing lines) Signs and barricades Non-conductive tag lines Warning lines erected Spotter required Encroachment Precautions for operations up to 350kV: At Least One of These Additional Measures Proximity alarm Range control warning device Range control prevention device Insulating link Table A – Minimum Powerline Clearance Distances – Operation Voltage Distance 0 to 50 kV 10 ft 50 to 200 kV 15 ft 200 to 350 kV 20 ft 350 to 500 kV 25 ft 500 to 750 kV 35 ft 750 to 1000 kV 45 ft
Yes No Not applicable
462. Work near overhead utilities - Corrective ActionsList Checkbox
Conduct planning meeting (discuss de-energizing lines) Erect signs and barricades Erect warning lines Provide Non-conductive tag lines Designate spotter as required Ensure minimum clearance distance per Table A
463. Reason for lack of protection near overhead utilities (Cranes)List Radio
Overhead Utilities hazard(s) not recognized Overhead Utilities control(s) not identified Overhead Utilities control(s) not implemented Overhead Utilities control(s) not executed
464. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
465. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
466. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
467. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
468. Adequate execution of lift plan? (Cranes)List Radio
Known weight of load Known Capacity of load handling equipment Anti-Two-Block Functional Rigging inspected and adequate for task Controlled lift zone Tag lines Designated signal person Qualified rigger Overhead load alert
Yes No
469. Execution of lift plan - Corrective ActionsList Checkbox
Determine/Verify weight of load Determine capacity of load handling equipment Install Anti-Two-Block device Replace rigging Establish controlled lift zone Provide tag lines Designate qualified signal person Assign qualified rigger Establish overhead load alert system Use the correct signal method
470. Reason for lack of executing lift plan (Cranes)List Radio
Load Handling hazard(s) not recognized Load Handling control(s) not identified Load Handling control(s) not implemented Load Handling control(s) not executed
471. What prevented the hazard from being recognized? Select all that applyList Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
472. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
473. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
474. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
475. Required Load Handling Equipment set up procedures in place? (Other than Cranes)?List Radio
Ground conditions sufficient for task Outriggers extended as required by load chart Lifting equipment level during lift Spotter or C.A.Z in place as needed Using manufacturer approved lifting points
Yes No
476. Load Handling Equipment set up procedures - Corrective ActionsList Checkbox
Improve ground conditions Extend outriggers per load chart Ensure lifting equipment is level Set up Spotter or C.A.Z as needed Use manufacturer approved lifting points
477. Reason for lack of set up procedures for load handling equipmentList Radio
Lift Set Up hazard(s) not recognized Lift Set Up control(s) not identified Lift Set Up control(s) not implemented Lift Set Up control(s) not executed
478. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
479. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
480. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
481. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
482. Safe procedures for work near overhead utilities (OLHD)?List Radio
Overhead Utilities (OLHD): Encroachment Precautions for operations up to 350kV: All of the following must be met: Planning meeting (discuss de-energizing lines) Signs and barricades Non-conductive tag lines Warning lines erected Spotter required Table A – Minimum Powerline Clearance Distances – Operation Voltage Distance 0 to 50 kV 10 ft 50 to 200 kV 15 ft 200 to 350 kV 20 ft 350 to 500 kV 25 ft 500 to 750 kV 35 ft 750 to 1000 kV 45 ft
Yes No Not applicable
483. Work near overhead utilities (OLHD) - Corrective ActionsList Checkbox
Conduct planning meeting (discuss de-energizing lines) Erect signs and barricades Erect warning lines Provide Non-conductive tag lines Designate spotter as required Ensure minimum clearance distance per Table A
484. Reason for lack of procedures while lifting near overhead utilities (OLHD)List Radio
Overhead Utilities hazard(s) not recognized Overhead Utilities control(s) not identified Overhead Utilities control(s) not implemented Overhead Utilities control(s) not executed
485. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
486. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
487. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
488. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures
489. Adequate execution of lift procedures? (OLHD)List Radio
Known weight of load Known Capacity of load handling equipment Rigging inspected and adequate for task Controlled lift zone Tag lines as required Designated signal person as required Qualified rigger as required
Yes No Not applicable
490. Execution of lift procedures - Corrective ActionsList Checkbox
Determine/Verify weight of load Determine capacity of load handling equipment Replace rigging Establish controlled lift zone Provide tag lines as required Designate qualified signal person as required Assign qualified rigger as required
491. Reason for lack of safe liftingList Radio
Load Handling hazard(s) not recognized Load Handling control(s) not identified Load Handling control(s) not implemented Load Handling control(s) not executed
492. What prevented the hazard from being recognized? Select all that apply.List Checkbox
Primary STCKY Energy not recognized Lack of Knowledge Inadequate training Lack of awareness Insufficient risk assessment Rushed planning or inadequate preparation Lack of communication Inadequate hazard identification process Unclear responsibilities Assumptions and biases External factors
493. What prevented the control from being identified? Select all that apply.List Checkbox
Lack of familiarity with specific high energy hazards - The project team is not familiar with the specific high energy hazards present in the task, i.e. new or unique situation or work process. Inadequate training on high energy controls - Team members have not received sufficient training on identifying, implementing, and executing high energy controls. Insufficient risk assessment - The team has not conducted a thorough risk assessment to identify all potential high energy hazards and determine appropriate controls. Lack of available control options - The team struggles to find suitable control measures for mitigating the identified high energy hazards, leading to delays or inadequate solutions. Resource constraints - Limited budget or access to equipment prevented the implementation of high energy controls Time constraints - Project deadlines and tight schedules pressure the team to overlook or rush the identification of high energy controls. Risk Tolerance - The team has dealt with similar high energy hazards in the past without incident and assumed the risks are manageable without additional controls. Emphasis on production - A focus on productivity and meeting targets led to neglecting the thorough identification of high energy controls. Lack of communication and collaboration - Team members did not communicate effectively, critical information about high energy hazards and controls were missed. Failure to learn from past incidents - The team did not learn from previous incidents involving similar high energy hazards, leading to repeated oversights in control identification. Complexity of the construction task - Highly complex task with multiple high energy hazards, made it challenging for the team to identify and implement appropriate controls for each hazard.
494. What prevented the control from being implemented? Select all that apply.List Checkbox
Cost considerations - High energy controls are expensive to acquire and install, and the project team prioritized cost savings over worker safety. Lack of understanding or awareness - The team did not fully comprehend the severity of the hazard or the potential consequences of not implementing the high energy controls. Resistance to change - Introduction of controls or procedures was met with resistance from workers or management who prefer familiar practices. Inadequate planning - The team identified the need for high energy control but failed to develop a proper plan for their implementation. Resource constraints - The team lacked the necessary resources, such as equipment or skilled personnel, to implement the high energy controls effectively. Time constraints - Project timelines or deadlines did not allow for implementing high energy controls properly. Lack of leadership support - The absence of leadership support in prioritizing control implementation made it challenging for the team to effectively implement the controls. Perceived inconvenience - Workers considered the high energy controls as inconvenient or cumbersome, leading to resistance in their implementation. Risk Tolerance - The project team believes that the hazard is manageable without additional controls or that accidents are unlikely to happen. Inadequate training - Workers lack the necessary training on how to use or maintain the high energy controls effectively. Miscommunication or misinterpretation - Instructions or guidelines for implementing the controls have not been communicated clearly or were misunderstood by the team
495. What prevented the control from being executed? Select all that apply.List Checkbox
Inadequate training - The team have not received sufficient training on how to use the high energy control properly Lack of supervision - Lacking supervision, workers did not follow the correct procedures for using the high energy control. Risk Tolerance - Workers became complacent over time and deviated from established procedures Lack of accountability - No consequences for non-compliance with high energy control procedures Failure to maintain equipment - Lack of regular maintenance and/or inspections of the high energy control led to malfunction and/or reduced effectiveness. Miscommunication or misunderstandings - Poor communication between team members resulted in misunderstandings about how to execute the high energy control. Production pressures - Workers prioritized production over control execution, due to tight project schedule or deadlines, leading to incomplete execution of the high energy control. Resource constraints - The team lacked the necessary resources to ensure high energy control execution. Lack of awareness - Workers did understand the importance of high energy control or the potential consequences of not executing it effectively. Worker fatigue - Fatigued workers were not alert or attentive when executing high energy controls. Competing priorities - Other tasks or issues diverted the team’s attention away from executing the high energy control. Willful disregard - Intentional neglect or avoidance of necessary actions or procedures

## 22. Causal Analysis - Safeguard Review

click to collapse/expand
Ask these questions about the person who was most involved in the incident.
496. Was a regulation or company policy violated?List Radio
Yes No TBD / Answer Pending
497. Was there intent to cause harm?List Radio
Yes No
498. Did a distraction contribute to the incident?List Radio
Yes No
499. Causal Factor: Lapse. Corrective Actions: Remove distraction, provide coaching on hazard recognition/awareness.Text Label
500. Was this a new situation where typical practices were followed?List Radio
Example - A new construction material was installed using typical practices for other materials.
Yes No
501. Causal Factor: Intrusion (of a new situation when typical practices were followed). Corrective Actions: Coach on hazard recognition/awareness, revise work plan.Text Label
502. Was a necessary step left out of the procedure?List Radio
For example- The task's JHA did not identify a critical step.
Yes No
503. Causal Factor: Omission. Corrective Actions: Revise work plan. Coach on Hazard recognition and risk tolerance.Text Label
504. Is the intent behind the action known?List Radio
Do we actually know why the person chose to do what they did?
Yes No
505. Causal Factor: Reduced Intention. Corrective Action: Coach on safe choices.Text Label
506. Was a sequence of tasks mistimed?List Radio
Yes No
507. Causal Factor: Mistiming. Corrective Action: Revise work plan, coach on hazard recognition and safe practices.Text Label
508. Causal Factor: Unclassified. Corrective Action: N/AText Label
509. Was there a rule/procedure AGAINST the action?List Radio
Yes No
510. Was it possible to follow safe practices?List Radio
Yes No
511. Did jobsite pressure drive disregard?List Radio
Yes No
512. Causal Factor: Uncontrolled Situation. Corrective Action: Support choice, revise work planText Label
513. Causal Factor: Jobsite Pressure. Corrective Action: Coach on Speak Up, Listen UpText Label
514. Was choice made due to a high tolerance for risk?List Radio
Yes No
515. Causal Factor: Jobsite pressure. Corrective Action: Coach on choices, coach on Speak Up, Listen UpText Label
516. Causal Factor: High Risk Tolerance . Corrective Action: Coach, discipline, re-trainText Label
517. Was there a rule/procedure FOR the action?List Radio
Yes No
518. Was the rule/procedure good in some circumstances?List Radio
Yes No
519. Causal Factor: Mistake- Application of a bad rule/procedure. Corrective Action: Provide training on hazard recognition and safe practices. Revise the work plan.Text Label
520. Causal Factor: Mistake- Misapplication of a good rule/procedure. Corrective Action: Provide training on hazard recognition and safe practices. Revise the work plan.Text Label
521. Causal Factor: Mistake- Knowledge-based mistake. Corrective Action: Provide training on hazard recognition and safe practices. Revise the work plan.Text Label
522. Additional corrective actions to be taken by our Sundt Project Management Team:List Checkbox
Plan the work, work the plan - Sundt project management to: revise work plans, schedules, etc. verified work is completed in accordance with plans Engage our workforce - Speak with workers / personnel about matters learned during this incident review process Walk our jobsites - Sundt project management to conduct more frequent STCKY Walks and safety inspections Coach our teams - Sundt project management to sponsor, hold, or conduct training on matters related to this incident. Own Relentless Housekeeping - Sundt project management to increase housekeeping efforts Report and manage incidents - Sundt project management to re-enforce/emphasize the importance of incident reporting during meetings, training, etc. None - n/a
523. Do other Causal Factors apply to this incident?List Checkbox
Competence/Training/Knowledge Transfer Standards, Policies, Programs, Processes Leadership Contractor Selection & Management Continuous Improvement Equipment, Materials, Environment None - n/a
524. Competence/Training/Knowledge Transfer: Corrective ActionsList Checkbox
Refine employee selection process Refine onboarding / orientation process Conduct analysis of training needs Refine training program Refine presentation of training Ensure adequate recordkeeping of training Ensure adequate refresher training Ensure sufficient training resources Provide training
525. Standards, Policies, Programs, Processes: Corrective ActionsList Checkbox
Update HSE System Manual - Latest version (https://www.sundt.com/downloads/#safetydownloads) Update Project HSE Plan - Latest template (https://www.sundt.com/downloads/#safetydownloads) Update HSEMP or other SOP
526. Leadership: Corrective ActionsList Checkbox
Clearly define responsibility / accountability / expectations Effectively communicate responsibility / accountability / expectations Clearly define communication within reporting relationships Ensure leaders set a good safety example Ensure leaders demonstrate commitment to safety
527. Contractor Selection & Management: Corrective ActionsList Checkbox
Enhance process for contractor prequalification Ensure prequalification of contractors Ensure adequate contractor selected Effectively engage contractors
528. Continuous Improvement: Corrective ActionsList Checkbox
Capture lessons learned and trends Communicate lessons learned and trends Act on lessons learned and trends
529. Equipment, Materials, Environment: Corrective ActionsList Checkbox
Ensure safe design Ensure safe arrangement Ensure purchasing protocols are followed Ensure adequate maintenance is conducted Ensure adequate condition Ensure availability Ensure safe work area
530. Division of Work that had a Design ProblemList Drop-down
What was the scope/division of work that caused/contributed to the incident? If a plumber doing roof drains fell over a roof parapet that was shorter than guardrail height, the Division would be roofing which is 07 Thermal and Moisture Protection (not plumbing)
531. Optional: Causal Analysis DetailsText Long

## 23. Attachments, Documentation, Photos

click to collapse/expand
532. Attachments / References / Photos / DocumentationAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
533. Confidential AttachmentsAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

## 24. Misc Details

click to collapse/expand
534. Optional: Did anyone assist with this report?Choice
If incident was an inspection by a regulatory agency, list the personnel who participated in the inspection process.
Yes No
535. Participants (aside from you)People
Select internal participants here. For personnel not listed, use the next field.
536. Other ParticipantsText Short
Type out any other participants' name & company.
537. Optional: Was the incident witnessed?List Radio
Witnessed Not witnessed
538. AuthoritiesChoice
Regulatory / Responding agencies (i.e., OSHA, Police Dept, Fire Dept, etc)
Authorities involved No authorities involved

## 25. Authorities

click to collapse/expand
539. Authority/DeptList Radio
DPS - Department of Public Safety Police Department Fire Department EMS - Emergency Medical Services Federal Law Enforcement Agency Other Agency – Describe Below
540. Name of Authority/DeptText Short
541. Officer NameText Short
542. Badge NumberText Short
543. Complaint/Report/Inspection NumberText Short
544. How many citations were issued?List Radio
0 1 2 3 TBD

## 26. Inspection by Regulatory Agency

click to collapse/expand
545. Regulatory AgencyList Drop-down
546. Name of Regulatory AgencyText Short
547. StateList Drop-down
548. Complaint/Report/Inspection NumberText Short
549. Compliance Officer NameText Short
550. Badge NumberText Short
551. Reason for InspectionList Drop-down
552. Inspection StatusList Drop-down
553. How many citations were issued?List Radio
0 1 2 3 TBD
554. Notes:Text Long
555. AttachmentsAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
556. Date and Time of Opening ConferenceDate time
557. Opening Conference: Persons in attendance (provide company names for external parties)Text Short
558. Was a search warrant presented?Choice
Yes No
559. Was the inspection based on a complaint?Choice
Yes No
560. What was the complaint?Text Short
561. Inspection DurationText Short
562. Upload photos taken during inspectionAttachment
Be sure to take the same photographs from the same angle as the inspector
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
563. Date and Time of Closing ConferenceDate time
564. Closing Conference: Persons in attendance (provide company names for external parties)Text Short

## 27. Inspection by Regulatory Agency - Citation #1

click to collapse/expand
565. Issue DateDate
566. Citation StatusList Radio
Open Closed
567. Citation IDText Short
568. Standard CitedText Short
i.e., OSHA: 1138192.015
569. Citation CategoryList Drop-down
570. Initial FineNumber
571. Final outcome of citationList Drop-down
572. Penalty Amount PaidNumber
573. Notes:Text Long

## 28. Inspection by Regulatory Agency - Citation #2

click to collapse/expand
574. Issue DateDate
575. Citation StatusList Radio
Open Closed
576. Citation IDText Short
577. Standard CitedText Short
i.e., OSHA: 1138192.015
578. Citation CategoryList Drop-down
579. Initial FineNumber
580. Final outcome of citationList Drop-down
581. Penalty Amount PaidNumber
582. Notes:Text Long

## 29. Inspection by Regulatory Agency - Citation #3

click to collapse/expand
583. Issue DateDate
584. Citation StatusList Radio
Open Closed
585. Citation IDText Short
586. Standard CitedText Short
i.e., OSHA: 1138192.015
587. Citation CategoryList Drop-down
588. Initial FineNumber
589. Final outcome of citationList Drop-down
590. Penalty Amount PaidNumber
591. Notes:Text Long

## 30. Citation #1

click to collapse/expand
592. Citation IDText Short
593. Issue DateDate
594. Standard CitedText Short
i.e., OSHA: 1138192.015
595. CategoryText Short
i.e., Other than serious
596. PenaltyNumber
597. StatusList Radio
Closed Open Deleted Pending withdrawal Reduced to notice Other

## 31. Citation #2

click to collapse/expand
598. Citation IDText Short
599. Issue DateDate
600. Standard CitedText Short
i.e., OSHA: 1138192.015
601. CategoryText Short
i.e., Other than serious
602. PenaltyNumber
603. StatusList Radio
Closed Open Deleted Pending withdrawal Reduced to notice Other

## 32. Citation #3

click to collapse/expand
604. Citation IDText Short
605. Issue DateDate
606. Standard CitedText Short
i.e., OSHA: 1138192.015
607. CategoryText Short
i.e., Other than serious
608. PenaltyNumber
609. StatusList Radio
Closed Open Deleted Pending withdrawal Reduced to notice Other

## 33. Witnesses

click to collapse/expand
If additional witness statements need to be inserted, this section can be duplicated-- click on "Copy Section". Interview Guidelines (https://www.csra.colorado.edu/_files/ugd/92d978_ffa43ea8f74a4ea383cd4b954414e4b2.pdf?index=true)
610. Copy sectionText
611. Witness Name & CompanyText Short
612. Witness StatementReference document
Use a computer to download the witness statement in Word format
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
613. Option 1: Upload witness statements as an attachmentAttachment
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
614. Option 2: Type/paste witness statements hereText Long
Sample questions to ask if needed: When did the incident occur (date and time)? How was the task planned? Was there a THA or work plan for this operation? Was the THA being followed as written? Where were you when the incident occurred? Where were others located when the incident occurred? Did others witness the incident? Do you know their names? What events occurred just before the incident? When was the incident/leak/problem realized? How far along in the operation were you when the incident occurred? How did the incident occur / What happened? What equipment, material, or personnel were involved? Where was the equipment, material, tool? Where was the machine in its cycle? Who installed the equipment? What was damaged? Who and what was injured? What happened after the incident? How could this be prevented from recurring? How are you connected with others involved in the incident? Would you like to provide any additional information?

## 34. Contact

click to collapse/expand
615. Best point-of-contact for this incidentList Radio
Me Non-Sundt Contact Other Sundt Contact Involved/Affected Party 1 Involved/Affected Party 2 Witness
616. Sundt Contact(s)People
617. Contact (Name, Company, Phone/Email)Text Short

## 35. STCKY Classification

click to collapse/expand
618. This incident is:Text Label
619. STCKYText Label
620. Non-STCKYText Label
621. How STCKY Classification worksReference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
622. Confirm the appropriate classificationList Radio
An incident must only have one official classification.
No applicable STCKY Classification Non-STCKY Near Miss Non-STCKY Damage Non-STCKY Injury STCKY Success STCKY Luck Near Miss STCKY Luck Damage STCKY Luck Injury STCKY Injury: Life Threatening STCKY Injury: Life Altering STCKY Injury: Life Ending
623. Notes/explanations/details on STCKY Classification (optional)Text Short

## 36. Incident Review Level

click to collapse/expand
After completing the fields on the report, the Incident Level will populate accordingly.
624. Confirm the appropriate Incident Review LevelList Radio
An incident must only have one official Level.
Level 1 - Level 1 Review Meetings are optional... Criteria: Non-STCKY: injury, damage, near miss Job site first aid (incl On Site & Occucare) Trade partner personnel go to clinic and receive first aid Damage, theft, or vandalism up to $1k Minor spills (released more than incidental use) Invite: Project Team (Project Safety Manager, Superintendent, Project Manager, etc) Area/District/Group HSE Manager Project Executive Level 2 - Criteria: STCKY Success (controls in place) STCKY Luck: injury, damage, or near miss Sundt personnel transported to clinic Trade contractor personnel treated at clinic for a recordable OSHA recordable injury Damage, theft, or vandalism over $1k Major spills (when govt reporting req’d) Notify: Supervisor, Safety Manager, Superintendent, Project Manager, Other project teammates Project Executive District/Group HSE Mgr Regional Director/District Manager Area/District Manager Paul Levin Invite: Project Team & Executive Regional Director/District Manager District/Group HSE Manager Group Manager Paul Levin Level 3 - Criteria: STCKY Injury (life threatening/altering/ending) Personnel transported to hospital Lost-time injury OSHA reportable injury Member of public injured Business interruption caused by property damage Government Inspection (OSHA|MSHA|EPA) Notify: Supervisor, Safety Manager, Superintendent, Project Manager, Other project teammates Project Executive District/Group HSE Mgr Regional Director/District Manager Area/District Manager Paul Levin Group Manager Mike Hoover Ron Stuff Invite: Project Team & Executive Regional Director/District Manager District/Group HSE Manager Group Manager Paul Levin Mike Hoover No Level - Criteria: Personal Medical Episode or Issue Sundt Driver Complaint STCKY Exposure Contact/Notify as relevant/appropriate: supervision of affected personnel Project Team (Project Safety Manager, Superintendent, Project Manager, etc) Area/District/Group HSE Manager Project Executive
625. STCKY ShareReference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

## 37. Submit

click to collapse/expand
626. Exclude this incident from OSHA 300 log?List Radio
Exclude
627. Exclude this incident from data collection, dashboarding, Snapshot, etc. ("Report Only")List Radio
Exclude
628. Select project teammates to receive notification (optional)People
629. Send for HSE reviewForm flow button
Workflow action placeholder.
630. Send for Corporate review AND distribute initial notificationForm flow button
Workflow action placeholder.
631. Send back to projectForm flow button
Workflow action placeholder.
632. Approve and CloseForm flow button
Workflow action placeholder.
633. Send back to groupForm flow button
Workflow action placeholder.

## 38. Compass Data Centers - Additional Required Info

click to collapse/expand
634. Project TypeList Radio
Datacenter
635. Project LocationList Radio
Goodyear, AZ El Mirage, AZ
636. Classification of IncidentText Short
For example, "arc flash"
637. List all companies involvedText Short
638. Problem StatementText Short
For example, " While performing L4 for PC 1F2 MSB an Arc flash Occurred"
639. Brief Description of Task Objective Prior to IncidentText Short
For example, " ARC Flash during L4 on PC 1F2 MSB"
640. How many hours worked for the day prior to incidentText Short
641. How many days worked consecutively prior to incident?Text Short
642. Does the PTWP address the specific task involved in the incident?Text Short
643. Were the proper tools and material used?Text Short
644. Provide the detailed timeline of events (before, during, and post incident)Text Label
645. Event timeTime
646. Event DescriptionText Short
647. Event timeTime
648. Event DescriptionText Short
649. Event timeTime
650. Event DescriptionText Short
651. Event timeTime
652. Event DescriptionText Short
653. Event timeTime
654. Event DescriptionText Short
655. Event timeTime
656. Event DescriptionText Short
657. Event timeTime
658. Event DescriptionText Short
659. Event timeTime
660. Event DescriptionText Short
661. Event timeTime
662. Event DescriptionText Short
663. Event timeTime
664. Event DescriptionText Short
665. Event timeTime
666. Event DescriptionText Short
667. Event timeTime
668. Event DescriptionText Short
669. Event timeTime
670. Event DescriptionText Short
671. Event timeTime
672. Event DescriptionText Short
673. Contributing FactorsText Long
For example: 1.Wire removed for relocation of terminal block for better access of EC on site. 2. Terminal block mounted too low on some units which made termination difficult. 3. The block mounting location not specified on any drawing.
674. Root CauseText Short
For example, "Wire strands crossed phases on terminal block when relocated to accommodate the connection from the bottom."
675. Corrective Actions and Measures to Prevent ReoccurrenceText Long
For example, 1. Review all GPZ Comm box for similar issues. SE site team In progress 2. Rework the comm box, replace wiring, terminal block, and breaker. SE site team Complete 3. Update terminal block mounting location on drawings. SE pre-fab engineer ongoing due 11/1/25 4. Review oversight and validation of contractor scope of work. Documentation to include inspection records.

## 39. Project-Level Incident Review Meeting

click to collapse/expand
Incident Review Meeting & Attendees (via Teams) schedule within 48 hours of the incident hold meeting within two weeks of incident send calendar invite to Review Mtg Attendees Subject line of invite: Level X Incident – Incident Type – Group Level 1 (Optional) • Project Team & Executive • Regional Director • District/Group Safety Manager Level 2 – Level 1 plus: • District Manager & Group Manager • Paul Levin Level 3 - Level 2 plus: • Mike Hoover, CEO
676. Start the review meeting with a discussion on Beliefs that were relevant to the incident:Reference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
677. Review Meeting Date & TimeDate time
678. Review Meeting AttendeesPeople
679. Additional Notes/Comments/Write-in AttendeesText Long
680. Finish the review meeting with a discussion on Actions that our team will take (in addition to other causal factors and corrective actions that were identified)Reference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

## 40. Sundt Leadership - Incident Review Meeting

click to collapse/expand
Incident Review Meeting & Attendees (via Teams) schedule within 48 hours of the incident hold meeting within two weeks of incident send calendar invite to Review Mtg Attendees Subject line of invite: Level X Incident – Incident Type – Group Level 1 (Optional) • Project Team & Executive • Regional Director • District/Group Safety Manager Level 2 – Level 1 plus: • District Manager & Group Manager • Paul Levin Level 3 - Level 2 plus: • Mike Hoover, CEO
681. Start the review meeting with a discussion on Beliefs that were relevant to the incident:Reference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.
682. Review Meeting Date & TimeDate time
683. Review Meeting AttendeesPeople
684. Additional Notes/Comments/Write-in AttendeesText Short
685. Finish the review meeting with a discussion on Actions that our team will take (in addition to other causal factors and corrective actions that were identified)Reference document
Note: saving JSON stores file names only; submit handling can be connected to SharePoint, Power Automate, or another endpoint.

## 41. Revision Log

click to collapse/expand
686. Input details on what was edited... Provide the date of changes and list the changes that were made. Add to this section as additional updates are made to the report (don‘t delete previous revision details). Examples of revisions to detail: Added attachments, Corrected errors, Documenting incident review meeting, Re-classifying the incident, Updating data related to worker compensation, etc.Text Long
Input details on what was edited... Provide the date of changes and list the changes that were made. Add to this section as additional updates are made to the report (don't delete previous revision details). Examples of revisions to detail: Added attachments Corrected errors Documenting incident review meeting Re-classifying the incident Updating data related to worker compensation etc

## 42. Insurance / Claims Info

click to collapse/expand
687. Incident will be filed as a claim with:List Radio
SLIP CCIP OCIP n/a
688. What is the insurance carrier?Text Short
689. Claim NumberText Short
690. Comments regarding insuranceText Short
691. Advanced Injury Classification OptionsList Checkbox
Permanent Transfer or Termination Permanent Disability
692. Email claims reportButton
Workflow action placeholder.
693. Generate 301 Report for Party 1Button
Workflow action placeholder.
694. Generate 301 Report for Party 2Button
Workflow action placeholder.