An accident investigation report summarizes a workplace accident that occurred on November 21, 2014 involving an employee named Julita. The direct cause of the accident was determined to be an unsafe act of discipline, as Julita was cutting a PCB board outside of the required safety box. This caused a piece of the board to fly into her left eye. As a result of the investigation, recommendations were made to enforce administrative controls like safety training and signage, as well as engineering controls like automated breaking equipment, to prevent similar accidents from occurring due to unsafe disciplinary actions.

1. Accident Investigation Report
Has occurred an accident on the date of 21
November 2014 on an employee of the
department PCBA , where the left eye of the
employees Exposed flake (particle) piece PCB
; at 11.30am.
- What happening…?
- Why Can Occur…?
- How to prevent…?
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2. Data of victims
Name : Julita.
Badge No : SPM-001251.
Position : MI Operator.
Sex : Female.
Superiors : Dimmer/Andik.
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3. Investigation Team
No. NAME OCCUPATION
1 Fahrizal N Safety Officer / Investigator.
2 Alboin PCBA Prod. Manager
3 Verini HR
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4. 4
Chronology of Accident
Phase I : Version of Victims (Julita), interview on 21 November 2014 :
08.00am : She start to do his job to cut/breaking PCB Model AMW0563.
11.30am : The accident occur, her eye Exposed flake (particle) piece PCB.
11.40am : Dimmer come to me to report that there (MI) has been a work
accident and also stated that the first Aid has been made (used
eyewash liquid to wash her eye), and inform the victim (Julita) has
now been in HR. And at the same time Dimmer also report to Alboin
as a H.O.D.
11.45am : I go directly to HR for interviews the Victims (Julita). She declare that
the particles remaining pieces of PCBs have flown on her left eye and
makes her extremely painful and difficult to see. I saw tears flowing
from his eyes continuously.
12.00pm : Verini bring her to the Hospital (CASA) for further help from the
doctor.
12.05pm : I go directly to the location of the accident at line MI. From
the location, can see the flake will not flied upward since already
protected by safety box (engineering control is there).

5. 5
Chronology of Accident
Phase I : Version of Victims (Julita), interview on 21 November 2014:
2.30pm : I got Information from Verini that the operator got MC for 2days.
3.27pm : I send email to PTM Director officially to inform that the accident
happened again. In accordance to the investigation I conclude that the
accident occurred due to the discipline issue.
Phase II : Version of Victims (Julita), interview on 24 November 2014:
8.30am : For the accuracy, in Monday morning (24 Nov’14) after the victims
is recovered I had interviewed back to double confirm, she declare it’s
cause by cutting PCB has been done at outside of protecting box.

6. Photo Location of accident
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Protecting Cover
Cutting / Breaking
PCBA

7. Cause of the Accident
Direct Cause.
1. Unsafe Act (Discipline).
- Cutting/Breaking PCBA outside protecting box (Safety box).
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Conclusion
Conclusion :
The accident occur caused by an undisciplined when doing his job.
It will be impact to the LDC back to reset “ZERO”.

8. Risk Control Recommendation
Substitution controls :
1. Engineering may provide breaking PCB Machine to eliminate manual
operation.
Administrative controls :
1. Brief operator’s to ensure cutting/breaking must be inside protecting box
without exception.
2. Need to provide Safety sign board (by the engineers).
3. Emphasis safety warnings on work instructions.
PPE controls :
1. Use Safety googles only for specified process which potential risk injures eye.
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9. What should be done…?
EVERYONE MUST ABIDE BY THE RULES
AND PROCEDURE AS WELL AS K3 AT ANY TIME
REMIND EACH OTHER
TO PREVENT VIOLATIONS CAN RESULT IN THE OCCURANCE
OF ACCIDENT.
ALWAYS KEEP THE SAFETY; STOP IF YOU FEEL
DROWSINESS, NO PPE, etc.
AVOID SHORTCUTS
REMEMBER THERE IS NO WAY SHORTCUT FOR SAFETY!!!
DISCIPLINE.
SAFETY CAMPAIGN
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10. Prepared By : Fahrizal N
Investigator
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“Safety is Shared
Responsibility”